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the lungs, and the pieces coming off from the cancer become showered through the blood stream and lodge at many points throughout the lungs. Each one starts a new cancer. At a certain stage in their development they look like nodules. Acute congestions, passive and active congestions of the lungs, may look nodular for a day or two. I have seen plates with shot in them. Of course, those look like nodules. There usually were not more than a few, though. I have seen plates with mycotic infectionsthat is, little parasitic plant-organism infections, molds—that have gotten down in the windpipe and been distributed at different points in the lungs, and show nodules. Those are relatively few in number. Usually you can count all of them, and they vary in size; the older ones will be the larger, the new ones smaller; and they very quickly become filled with calcium carbonate, or a chalk-like deposit by which nature kills off the mold, and then those remain permanently in the lungs.
Question. Are the nodules in these X-ray films you have just referred to large or small or medium, in your opinion?
Answer. They are all three. Most of them are medium. Some of them are large; I would say not medium. Most of them are small. The next group in number are medium in size. Some of them are fairly large. The process is progressive; it is going on, and new ones are still forming.
Question. Have you examined many other silicosis patients, or so-called silicosis patients, at the instance of Dr. Harless, since you made this trip to West Virginia ?
Answer. No, sir.
Question. You made no examination of any person except Raymond Johnson?
Answer. That is all.
Redirect examination by Mr. PACON: Question. Doctor, tell the jury how long an exposure to silica dust containing from 98 to 99 percent silica is necessary to contract the disease of silicosis.
Judge LEE. We object. I think that was gone over.
The COURT. The objection is overruled. You covered that pretty closely, but maybe not completely. He may answer. Answer. I have seen a number of cases that occurred under 1 year,
By Mr. BACON : Question. I outlined as best I could the conditions under which Raymond Johnson worked in the hypothetical I asked you a while ago.
I will ask you to tell the jury, in your opinion, how long it would take a person working under the conditions outlined in that question to contract the disease of silicosis in a sandstone containing from 98 to 99 percent silica.
Objection; overruled; exception.
Answer. The more susceptible will contract it in 4 months; the mediumly susceptible in 6 to 8 months; the more resistant in possibly a year or a year and a half.
Question. Doctor, are you familiar with the methods used in preventing employees from contracting silicosis in industries where they deal with silica rock?
Answer. Yes, sir.
Mr. COUCH. We object, our Honor, unless that is confined to the kind and character of work and under the conditions which appertained in tunnel no. 1.
Mr. BACON. I will add to that:
Question. Such as indicated and described in my hypothetical question, pertaining to tunnel no. 1-project no. 1.
Answer. The men should be selected upon a physical examination basis to begin with. They then should be restricted to short shifts of work. I would recommend 6 hours, perhaps 8, if my other conditions would supervene. They should be given not more than 542 days per week work, and every holiday that come along. Oversight should be had of their living and nutritional relationships. The medical service provided should take care of their trivial ills just as it does of their accidents; remove men who have any lung symptoms or heart symptoms promptly should they get them after these precautions. The workplace itself should be treated from an engineering standpoint so as to keep the dust at an absolute minimum within the knowledge of engineering science. That dust should be kept so that the countable particles, for example, are below two or three million at most per cubic foot, because we realize that there are many dusts that can't be counted—too fine if there is dust countable. That is done by various methods. Water will reduce the dust tremendously, as I have already recited; vacuum jackhammers or dust traps attached to the drills to catch the dust as produced immediately from the drill and lead it away; cleaning up repeatedly the floor and the gob remains with vacuum suction; keeping the place brilliantly lighted, so you can see whether dust is present in the air, because if it is poorly lighted it is more difficult to see it; making dust counts repeatedly and continuously, to see that these methods are effective; staying away after the shots for several hours, unless means are used to confine the dust and the products of the explosions; keeping the temperatures down by all means known, such as evaporation of water; keeping fumes out, so that men won't have to breathe deeper to get their air. The men should be given a lunch period, half an hour at least, in the midst of this spell.
Judge LEE. Are you through, Doctor? The WITNESS. Yes; practically. Judge LEE. If Your Honor please, we move to strike out that answer. As Your Honor indicated this morning, a great deal of that consists of what I take it the jury may have to pass upon this case.
Mr. BACON. I have another question, Your Honor, that I want to ask him before you rule on that.
Question. Doctor, I wish you would tell the jury whether or not the methods that you have outlined are the usual and customary methods used in industries where they handle sandstone with the presence of silica in it, as I have indicated in my former question.
Objection; overruled; exception.
Answer. Some, and over half perhaps, of those are used in many industries to prevent silicosis.
Judge LEE. We move to strike out the last answer, as well as the next to the last answer.
Motion overruled ; exception.
Answer. The ventilation should be the same as in mines, the usual standard of 100 cubic meet of fresh air from the outside per man per minute; 150 per animal per minute; at the head of that face.
Mr. COUCH. We object to the question and the answer thereto, and more to strike out the answer.
Objection and motion overruled; exception.
Mr. BACON. If dust was present in the tunnel, project no. 1, while the plaintiff was working therein, in large quantities, state whether or not 100 cubic feet of air per minute would be sufficient.
Answer. It would not.
Mr. Couch. We object to the question and the answer thereto, and move to strike out the answer.
Objection and motion overruled ; exception.
Question. What should be the velocity of the air in the tunnel if the conditions were such as I have described in my hypothetical question?
Objection; overruled; exception.
Answer. It should depend upon the number of men present; be multiplied by 100 cubic feet per minute.
Question. There is some evidence in this case, I believe, that the velocity of the air in project no. 1 was 6 feet per minute, and I have stated, I believe, in the hypothetical question that there were sixty to seventy men employed inside the tunnel at each shift. What have you to say as to the sufficiency of the velocity of that air?
Objection to the question and any answer to it. Objection overruled; exception. Answer. It would not be sufficient. (Witness stands aside.) Mr. MARCANTONIO. I now wish to offer in evidence the testimony of Dr. A. C. Lambert, which testimony was given in the trial of the case of Raymond Johnson.
Mr. GRISWOLD. Without objection, it will be received in evidence. Mr. MARCANTONIO. It reads as follows:
Dr. A. C. Lambert, introduced as a witness on behalf of the plaintiff, having been first duly sworn, testified as follows:
Direct examination by General LILLY:
Question. Doctor, I wish you would just detail to the jury as fully as you can, without being too modest, your education in a medical way, and, if you have it written down there, I would be glad for you to refer to it, giving your experience and qualifications.
Answer. Four years high school, Ceredo, W. Va.; 2 years in Marshall College; 4 years in the Eclectic Medical College, Cincinnati, Ohio, graduating in 1909; interne, Seton Hospital, Cincinnati, Ohio, 1 year; from 1910 to 1917 in general practice, at that time with the use of a small X-ray machine.
Question. Where was that, Doctor?
Answer. In Charleston; 1917 to 1919, United States Army; 1919 to 1922 in the general practice of medicine; 1922 to 1929, chief roentgenologist, Mountain State Hospital, Charleston, W. Va.; 1930 established an X-ray laboratory at 612 Bank of Commerce Building, in the city of Charleston, W. Va., of which I am the owner and operator.
Question. Now, you speak of being in the Army. In what capacity were you there, as a doctor?
Answer. I was there as a medical officer. During this time I took postgraduate work at the West Side and Cook County Hospital, Chicago, Ill., in 1922. In 1923 I studied diseases of the chest with Doctors Dunham, Seavelin, and Wooding, of Cincinnati, Ohio; 1923, instruction at the Tubercular Sanitarium, branch hospital, Cincinnati, Ohio; 1923, special instructions in deep therapy and treatment instructions with Dr. Schroider, of Cincinnati, Ohio; 1924, diseases of the digestive system and interpretation of stomach and intestinal films, with Dr. O'Brien, of Chicago, Ill. ; 1925, X-ray interpretations and diseases of the chest, postgraduate, at Tulane University, New Orleans • 1926, study of mastoids, antrums and sinuses, their diseases and interpretation of plates, with Dr. Andree Cranger, New Orleans; 1926, study of teeth, their interpretation from X-ray films, with Dr. Kells, of New Orleans. I have studied bone pathology in the various clinics throughout the United States. I am a member of the American Radiological Society of North America, and have been for many years.
Question. I see you refer to Dr. Dunham and two others with whom you studied, or under whom you studied in Cincinnati. Just hurriedly speak as to who Dr. Dunham is in the X-ray world.
Answer. Dr. Dunham is one of the foremost men of the world in the diagnosis of chest conditions, their interpretation from X-ray films.
Judge LEE. We object to that last answer and move to strike it out.
By Mr. LILLY: Question. Doctor, are you in the active practice of medicine at this time? Answer. I am specializing in radiology. Question. What are your special duties in that? Answer. The taking and interpretation of X-ray films. Question. How long have you been specializing in radiology? Answer. Since 1922. Question. How long, if at all, did you practice general medicine? Answer. From 1909 until 1922.
Question. Tell the jury, Doctor, about how many X-rays, including chest and other parts of the body, you would say you have taken and interpreted.
Answer. I couldn't say. Thousands of them.
Question. What do you have to say as to X-ray of chest; how many have you taken and interpreted?
Answer. Well, I have taken thousands of those.
Question. Tell the jury to whom you interpret X-rays, and how that is handled.
Answer. The physician refers the case to me; I take the picture and give him my opinion in the form of a consultation as to the condition of the patient.
Question. Doctor, tell the jury in a general way what experience, if any, you have had with reference to silicosis.
Answer. The silicosis that I have seen has been the general run of patients who would be referred in this part of the country for X-ray examinations. In the 11 or 12 years that I have devoted myself to this specialty I have seen about 30 cases.
Question. Where has that work been done, Doctor?
Question. Tell the jury whether or not silicosis, if you know, is an occupational diseases.
Answer. It is so classified.
Answer. From literature it is said to be about 12 or 15 years, something like that time.
Question. Before that time was there such a disease known by different medical terms or names?
Answer. Yes, sir.
Question. How long has that been generally known, silicosis, by these other names?
Answer. Possibly as long as there has been medicine.
Question. Doctor, tell the jury whether or not you had occasion to X-ray the plaintiff here, Raymond Johnson.
Answer. Yes, sir.
Answer. My name is photographed on it, with the date, March 16, 1933, and the laboratory number of the film, 2513.
Question. Is there more than one of them?
Question. Explain to the jury the technique of taking these and why there are two taken at the same time of the same patient.
Answer. We make two films of the chest when we desire to make a diagnosis of a pathological condition. That is done by the dropping of the tube, taking a picture with one tube, with the tube in this position; after that picture is taken that tube drops, at the same time a plate changer, which contains cosets or holders for these films, the one that you took first, at the time that tube changes the plate changer changes and another film comes into view, and another film is taken. If you will note, it is taken from two angles by the tube dropping a distance of about 4 inches.
Question. Tell the jury the practical purpose of that, Doctor, and especially having reference to the chest.
Answer. The purpose for that is so that when the plates are dry they can be put into what we call a stereoscope, which is an instrument that contains two view boxes or boxes with glass over the front of them, with strong lights back of them, so that the light shines through the film. One is put over here and one here in this view box; then in the center of the frame there is a triangular mirror, and you look with one eye into one mirror and the other eye into the other mirror, and adjust those plates so that they come together, and instead of reading a flat plate like when you look at those plates there, you see a condition that looks round, like the chest would if it was just the ribs there and seeing what is inside of it. It gives a third dimension, or depth.
Question. Does that put you in position that you can see inside of the chest?
Answer. Oh, yes.
Question. This plate here has length and breadth, but the stereoscope gives another dimension, thickness?
Answer. That is the idea; yes, sir.
Question. Did you examine the X-rays, or X-ray referred to bere, with a stereoscope?
Answer. Yes, sir.
Question. I will ask you to state, Doctor, what you did in a preliminary way, if anything, before you took the X-ray, or did you just primarily take the X-ray?
Answer. That is all.
Question. I will ask you to state what you observed, if anything, with reference to the bones.
Answer. The bones, so far as we could tell from these plates, were normal.
Question. What did you observe with reference to the effect on the pectoral muscles?
Answer. Well, they could be slightly seen on the plate.
Question. Now, Doctor, I wish you would tell the jury in a general way what the X-ray showed the condition of Mr. Johnson to be with reference to his right lung.
Answer. The right lung shows a diffused mottling over the mid-portion. The apices—that is, the top of the lung—and the bases of the lung are less marked. The right hilar region, or root of the lung in toward the heart, is very dense. There are numerous nodules throughout the entire right lung. The greatest area of density of the right lung is in the subelavicular region, just below the clavicles. These nodules are beginning to coalesce or group together, getting larger. There is marked fibrosis throughout the greater part of the right lung.
Mr. Couch. We object to that answer. He says these nodules are beginning to grow larger, and, from his X-ray plates, I don't see how he could tell that. He is only talking about one of them. How does he know they are getting larger? We, therefore, move to strike out that portion of his answer.
General LILLY. I would like to ask another question.
Answer. Simply because they are still in a state of activity; they are not completely fibrosed. There are large ones and small ones, and a beginning group that you can see in some places and in other places not.
Mr. Couch. I move to strike out the answer.
By General LILLY: Question. Did you also have occasion to see an X-ray of Mr. Johnson that was taken some 10 months before yours?
Answer. Yes, sir.
Question. Have you told the jury, so far as you now recall, the condition you observed from the X-ray of the right lung? Is there anything else you left out?
Answer. No, sir; that is all.