7.3.5: *Pneumoconiosis Three Cases*

Hamilton, James A. 1925. “Pneumoconiosis—Three Cases Two of Silicosis, and One of Anthracosis with Tuberculosis Superinduced. Complete Histories with Temperature Charts, X-Ray Pictures and Colored Plates of Lungs,” State of New York Department of Labor Bulletin. (The Division of Industrial Hygiene, 1925) 10-14. CASE No. 70581

PLATE NO. 30872 April 12, 1922

Sputum examination for T. B. — negative.

// regular examinations //

April 13, 1922 Sputum examination for T. B. — negative.

April 17, 1922 Sputum examination for T. B. — negative. Temperature subnormal, flighty. Pulse 90 to 100.

// inscription of the subject //

Respiration 20 to 30. Medication, Browns mixture.

// as to the metrics that are used in diagnosis //

Urine examination — negative. No current history notes.

April 20, 1922 Tubercular Division. Physical examination. Chest. Tactile fremitus about equal. Percussion higher pitched and less resonant in the right. Both bases hyper-resonant. Bronchial breathing over both upper lobes and middle of left lung. Few dry rales. S —

May 5, 1922 Moist rales heard both upper apices posteriorly. Increased vocal fremitus in left upper and prolonged. Harsh expiration. Percussion equal both sides. S

June 20, 1922 Prolonged harsh expansion over mid left scapular region. Increased vocal fremitus over both upper and mid posterior. S.

July 7, 1922 Sputum examination for T. B. — negative.

July 12, 1922 Prolonged harsh expiration left upper and middle. Few subcrepitant rales in left upper apex anteriorly and posteriorly. Vocal fremitus increased on left upper and middle. S.

August 8, 1922 Sputum examination for T. B. — negative.

August 11, 1922 Harsh bronchial breathing over left upper lobe with rales. Cavernous breathing and whispered pectoriloquy in right apex and bronchial breathing in right middle. R.

September 19, 1922 X-ray examination no. 30872. Clinical diagnosis. Chronic pulmonary T. B. Thorax. Lungs, left: There is a coarse, confluent mottling of almost consolidation from the 4th to 7th ribs and a confluent, hazy mottling from the 4th to the apex. From the 7th to the 9th ribs mottling decreases as the 9th rib is approached.

Diaphragm has accentuated dome. Apparent adhesions with the pericardium. Angle is clear.

Right: Hilus is increased in size and density. There is a confluent coarse mottling of consolidation from apex to 8th rib and a flocculent mottling from the 8th rib to the diaphragm. Diaphragm dome shape, adhesions at the crest of the dome. Orr.

// months of illness and a failure to describe the illness through the sputum //

September 29, 1922 Cavernous quality of breathing in left interscapular and scapular region. Bronchial breathing over rest of left chest with rales. Cavernous breathing in right apex. Diminished breath sounds in both cases. R.

October -, 1922 Cavernous breathing in right apex anteriorly, with whispered voice. Harsh bronchial breathing with cavernous quality. Expiratory note in both interscapular regions particularly the left with bronchophony. R.

November 11, 1922 Physical examination. Harsh bronchial breathing to amphoric in both apices with whispered pectoriloquy and decreased vocal fremitus. Interscapular region both lungs give harsh amphoric type of breathing suggestive of cavity. Chest nearly fixed. Expansion poor, percussion note nearly flat in both uppers.

November 14, 1922 Sputum examination for T. B.— Negative. Urine examination acid. sp. gr. 1.020 albumen negative, sugar negative.

X-ray No. 32932. Clinical diagnosis : Chronic pulmonary T. B.

// but these failures //

// are met and inverted, through the technologies of vision //

// to see the lungs //

Left lung: There is a coarse confluent mottling of almost consolidation from the 4th to the 7th ribs. Below the 7th rib is à confluent flocculent mottling extending down to the 9th rib. Diaphragm is at the 9th interspace. Indistinct outline in the inner half of the dome. Clear outline in the outer half. Right lung: There is a coarse confluent mottling of consolidation from the 4th to the 7th rib and a confluent, flocculent mottling from the 7th rib to the 9th. Pleura is thickened in the apex. Diaphragm is at the 9th interspace, indistinct outline with adhesion at the crest of the dome. Orr.

Temperature — subnormal, pulse 90 steady, respiration 20 to 26. Medication. Brown’s mixture.

December 27, 1922 Expansion limited. Percussion note flat. Dull over both sides of chest from apex to base. Harsh cavernous breath sounds with rales crepitant, sibilant and sonorous. Whispered pectoriloquy over an area as large as the palm in upper right chest anteriorly and posteriorly.

Diagnosis : Chronic fibroid phthisis — cavity. T.

Silicosis: Lung from male, 60 years of age and a worker in a stone quarry for 15 years, showing a thickened pleura simulating a layer of cartilage, a firmly solid compact cut surface, bluish gray color with no traces of vesicular structure. No traces of broken down lung tissue or any suggestion of old or active or later T. B. The peri-bronchial lymph nodes are enlarged and of a slate blue color. Tubercle bacilli not found. January 21, 1923

// the tracing of disease//

Physical examination. Asthmatic type of chest and almost immobile. Dullness on percussion over both apices, increased resonance over the entire left side. Both bases are hyper-resonant.

// through image //

// and the hands of doctors //

// tapping on this man’s chest //

Breath sounds are harsh over entire left with a blowing character at the left apex. Few rales and no moisture heard in either side of chest — T — Medication at this time was bicarbonate of soda T. I. D. No current history notes.

February 16, 1923 Sputum examination for T. B. negative.

// it continues //

// the doctors inscribe this man //

March 26, 1923 Sputum examination for T. B. negative.

// in their brief, descriptive notes //

April 3, 1923 · Sputum examination for T. B. negative.

// in this publication //

No current history notes. Nurses’ notes show patient had a severe cough of which he frequently complained as well as shortness of breath and pain in the stomach and left side of chest.

// in the projection of this video feed //

May 7, 1923 Patient died on the 411th day in the hospital.

Autopsy

W. D. Age 61. Laborer in stone. Clinical diagnosis, chronic pulmonary T. B., fibroid T. B.

Heart: Weight 10.5 ounces. Right ventricular wall showed a moderate degree of hypertrophy. Valves and orifices clear. Aorta and arteries clear.

// i find it so strange //

Respiratory organs: Pleural cavities. Firm fibrous adhesions in both pleural cavities with markedly thickened pleura especially over the upper two-thirds of both lungs.

// how little the description was //

Left lung: Weight 39 ounces. The thickening of the pleura is so marked as to appear like a layer of cartilage.

// how vague the patient seemed //

The lung is so firmly solid and unyielding, that it cannot be indented.

// how impersonal these notes describe his life //

// a faceless laborer //

On cutting there is a distinct gritty feel to the cutting edge. The cut surface shows a uniform bluish gray color with no traces of vesicular structure. The lower lobes are emphysematous.

// now transformed, in death //

// to an array of data //

The blebs being very large. No traces of broken down lung tissue or any suggestion of old or active or later T.B. Smears from scrapings from cut surface are negative for T.B. The mucous membrane of the bronchi is diffusely congested and numerous strings of fibrinopurulent exudate exudes from the cut end.

// sketched and written //

The peri-bronichal mediastinal lymph nodes are also enlarged and of a slate blue color.

Spleen: Weighed 8 ounces. Is pale and firm. Substance reddish brown. Malpighian body distinct.

// dissected and measured //

Urinary Organs: Negative.

Kidney: Weight 4.5 ounces. There are a number of cystic formations that appear underneath the capsule, which is adherent and on stripping leaves a granular surface; cortex is narrow.

// for us to inspect ourselves //

Digestive organs O.K.

Liver: 38 ounces, not remarkable.

// while that erasure does nothing //

Gall bladder: Clear. Anatomical diagnosis. Pneumonoconiosis. Chronic fibroid pneumonia, Chronic fibroid pleurisy, Chronic multiple emphysema, Chronic bronchiectasia, Bronchitis, Chronic interstitial nephritis. J.

// but support these bloodied hands //

Histological report: The bacteriology of lung is negative for tubercle bacilli. Histology sections from the lung show marked fibrosis. No tubercles with considerable deposits in fibrous areas of amorphous material. Some of the vesicles show pneumonic exudation undergoing fibrous organizations.

Kidneys: There is both parenchymatous and chronic interstitial change.

Liver. Shows an increase of small, round cells in the interlobular connective tissue. Nothing to add to gross diagnosis.