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1. . -- - stantlnra FOrar ana ;~ Rev. Jan. 1951 ~ . Promul`atal By Bureau o/ the Budget CltCuler A -32 Opo N3-16--11434-1 g 5209 Do CLINICAL RECORD I TISSUE EXAMINATION l ORIEF CLtNICAL HISTORY (ludude dnration oJJrBoA and royidiqr oJ promtA. iJa ntoptann) SIGNATURE ANO TITLE Enviro Contro PATHOLOGICAL REPORT NAME OF LACORATORYLaboratOry of the Senior Me ca . ACCESSION NO(s). Investigator, VA Hospital, East Orange, NJ j Dog 5209 (Orots dertriptfea, Mslo(oote azaalloaNon and diagnoses) . The mucous membrane cuts with usual rPsistance. The muscle is firm and browna cords andYinfraglottic region is smooth and grey. Lying in the anterior wall of the trachea is an oval opening which measures 7mma by 8mma The opening is lined The mucous::membrane of the epiglottis; aryepiglottic folds, true and false vocal by a grey surface. The remainder of the trachea, major bronchi and branch bronchi is smooth and'grey. (Continue on reve:se side) rATIENT'8 IDENTIFICATION (For typadorw•ritten entries pira: Narns-last, firat, I REGISTER NO. i d dl.;• , iddl.; drade; date; hospital or medical facility) m

DATE OF ADMISSION Y./. GGY[NN9Ltl1 MINf1N0 orfIc[ eW-IM-910IS-I -lol)-Ce! CLINICAL RECORD ~ NARRATIVE SUMMARY Dog 5209 , pleura are smooth and grey. 4 = visceral surface of the parietal pleura and the'parietal surface of the visceral " the mediolateral direction and 5;jcm. in the antercposterior direction. The The right lung in a fixed state mealsures 21cm. in the apicobasal direction, 911cm. are smooth and grey. ace o e visceral pleura t .surface of the-parietal pleura and the parietal sur f f h riediolateral direction and 3hcm. in the anteroposterior direction. The visceral DATE OF DISCHARGE ` / NUMBER OF DAYS HOSPITALtTED "` 11/ Page 2 {SiEn:nd dAFoi en ol"ri7- ... ~ ,~ The left lung in a fixed state measures 21cm. in the apicobasal direction, 11cm. inrthe The left apical lobe measures 9hcm.jin its greates-t apicobasal direction. 'The tissue cuts with slightly increased resistance_anil in the superior portion shows the presence of occasional fine grey bands. At the periphery of these grey bands 9 are occasional dilated air-sacs, which measure less than lmm. in diameter. In the_- remaining aspects of the lung the tissue is resil:.ent and brown in appearance. The left cardiac.lobe measures 511cm. in its greatest apicobasal direction. The tissue cuts with very slightly increased resistance and on section shows occasional ~fine grey bands in the superior portion of the lobe. At the periphery of these ,. .,grey bands are occasional dilated air sacs, which measure less than 1mm. in diameter. In areas within the lung there are red firm foci, which measure 5mm. in diameter. The greater portion of the remainder of the lung -,-etains its resiliency and is red brown in appearance. ~ present within the lobe. These measure 5mm. to 1cm, in diameter. The remainder of focus is loiated just beneath the pleura. The base of the wedge lies just'beneath -the pleura. The apex toward the hilum of the lung. Other small firm red areas are The left diaphragmatic lobe measures 10cm. in its greatest apicobasal direction. Shining through the pleura in one area within the lobe medially and extending to the base is a firm wedge-shaped focus whicll measures 5cm. in its apicobasal direction. Thi '.the lobe retains its resiliency and is brown in appearance. tissue cuts with very slightly increased resistance and shows the presence of 'jN The right apical lobe measures 11cm. in its greatest apicobasal direction. The 3fand.rd torm !01 Re.. Auqw1 1954 Bureau of Me Bud9e/ Urculor A-32 .occasional fine grey bands. At the periphery of these fine grey bands are occasional '. dilated air sacs which measure less than 1mm. in diameter. In other regions within z1 the lung, the tissue retains its resiliency and js brown in appearance, (Uae additional sheets of thfs form (Standard Forri 502) if mare apace is required) 31GNATURE OF PFlY5lC1AN I DATE I IDENTIr ICATION NO. I ORGANIZATION . PATIET(T'a IDENTiFICATION (For tFp ed or w,ritten.ent,rfea g1ra,;1llamr/ast,lirat, middle; /rade; dato;.hoapita2.or atadioaLlarrlity)

ry : ftandard f.rm 302 Rrr. Ao9a0 1934 {Y/..Y of Its. /udQ.1 . Chculer A-32 V.S. :Q.SII.~iYT P1J'iTIr.0:11c: c44"•14-'17I4/, I 40Is u• CLINICAL RECORD ~ NARRATIVE SUMMARY Dog 5209 DATE OF ADMISSION DATE OF DISCHARGE strands are occasional dilated air sacs which measure less than lmm. in diameter. grey strands are present within the lobe. At thQ periphery of these fine grey The tissue cuts with usual resistance and is brown in appearance. Occasional fine The right intermediate lobe measures ~;Icm. in its greatest apicobasal direction. ,its resiliency and is brown in appearance. .firm red 'areas which measure from 5mm. to 1cm. The remainder of the lobe retains tissue cuts with slightly increased resistance and in areas show occasional NUMBER OF DAYS HOSPITALIZED Page 3 (Sign and dat. at and of narratir.) The right cardiac lobe measures 63gcm. in.its-greatest apicobasal direction. The air sacs which measure less than 1mm. in diameter. The right diaphragmatic lobe measures~9cm. in its greatest apicobasal direction. The tissue cuts with usual resistance and on section shows occasional fine grey strands present in the superior portion of the lobe. At the periphery of these grey strands and in the subpleural aspects of the lobe are occasional dilated are grey-brown in appearance and measure 12mm. TRACHEOBRONCHIAL LYMPH NODES The left superior tracheobronchial lymph nodes cut with usual resistance and on section The left inferior tracheobronchial lymph nodes measure 10mm., cut with usual resistance and on section are grey-brown in appearance. resistance and on section are grey-brown in appearance. The right superior tracheobronchial lymph nodes measure 15mm., resistance and on section are gre-brown in appearance. cut with usual The right infarior tracheobronchial lymph nodes•measure 16mm., cut with usual .usual -amount of subepicardial fat present. There is also the usual amount of clear :parietal surface of the visceral pericardium are smooth and shiny. There is the The heart weighs 120.1gms. The visceral surface oc' the parietal pericardium and the fluid present within the perica;dial cavity. stooth. The auricular appendage is filled with a firm red clot. The tricuspidvalve .The wall•of the right atrium measures 1mm. in thickness. The endocardial surface is (Use additional sheeta of this form (Standard Form 502) if more space is required) EIGNATURJC OF PKYSlCIAN • I DATE IDENTIFlCATtON NO. I ORGANIZATION rAT1F!(T'31DENTtFICI~ITION (For t~p.d or wAfttaa..n~riss ~ir.alKaOirlaat, arrat. REGISTER NO. midd Irada; data l.; .• d~osptal.ar audisaLtarilitr)

. Sfandard Ierm 302 Rev. Aa9aU 1934 Rw.au a(IM ludp.t Qeeulaa A-32 u.9. cor[.br[Nr r1[1Mr!`- onKc CLINICAL RECORD I NARRA,TIVE SUMMARY Dog 5209 DATE OF ADMISSION I DATE OF DISCHARGE ( NUMBER OF DAYS HOSPlTAL12E0 i' Page 4 fs1/rrsmfid.ef.fh.wiof,.6 r.rirrJ--. --- 1! :measures 6cm. in circumference. The free edge is thin. The chordae in areas fused. They are not thickened and are not shortened. are « The trabeculae carneae and papilla muscles are round. The muscle of the-ventricle is firm an4 brown as is the muscle~f the interventricular septum. :u--1'. 4w0--1 aoo-u:.v tendineae The wa11 of the right ventricle measures 3mm. in thicknes. -The apex is sharp. They are not thickened and are not shortened. in circumference. The free edge is thin. The chordae tendineae are in areas fused. ` smooth. The auricular appendage is patent. The mitral valve measures 431cm. The wall of the left atrium measures 2mm. in thi--kness. The endocardial surface I is ostia are patent. The coronary arteries contain no yellow athermatous plaques along their course. The wall of the left ventricle measures 11mm. -in thickness. The apex is sharp. -'The trabeculae carneae and papillary muscles are rounded. The aortic valve measures 23icm. in circumference. The aortic cusps are not thickened, not shortened and are not fused. The coronary arteries arise in their usual location. The coronary AORTA along the course. The aorta retains its resiliency. There are no yellow athermatous plaques present VEINS The lumens of the veins are patent. The walls are thin and pliable. No thrombi are present< " LIVER prominently. It The liver weighs 427.7gms. The liver edge is sharp. The liver surface is smooth and brown. The tissue cuts with usual resistance and the sinusoids stand out 1mm. in thickness. The cystic, hepatic and common bile ducts are patent, The gallbladder contains the usual amount of clear green bile. The wall measures (Uss additional sheets of this.form (Standard Form 502) if more space is required) 31GNATUBE OF PtLYS1ClAN DATE I IDENTII'ICATION NO. I ORGANIZATION . ' PATIENT'3 IDENT1PiCATION (For iFp.d or w,utteitanLrisa dire.;,Nama-lsat,lPrat, middle; gradat dAta; trospita7.or amdiotUaulil7) NARRATIVE SUMMARY , ~ etanaara F)Drm aoz so.-1o7 .,.

St.nd.rd rsra+ 302 Rev. Aoqost 1934 6ur.au ef Ihe ludg.t arcvlor A-32 CLINICAL RECORD ~ DATE OF ADMISSION ! DATE OF DISCHARGE e.f. 60tN/.9ClT PItYTIN00rrICE r,1:1--10--a1t)0-1 4Illi-CY1 NARRATIVE SUMMARY Dog 5209 ( NU.A9ER OF DAVS HOSPITALIZED Page 5 (Si(n and date at end of narrative) The spleen weighs 32.8gms. The capsule of the spleen is wrinkled and grey in appearance. The tissue cuts with uspal resistance and on section the splenic corpuscles stands out prominently. I 0 7mm. The mucous membrane of the calyces, pelvis and ureter is smooth and rede junction. The cortex and medulla together measure 12mm. The cortex alone measures The right kidney weighs 33.2gms. The capsule strips with ease leaving a smooth surface. The tissue cuts with usual resistance and on section the cortex stands out prominently from the medulla because of a congestion at the°corticomedullary lipid present within the adrenal cortex. KIDNEYS The adrenals are present in their usual location. There is the usual amount o The cortex and medulla together measure 12mm. The cortex alone measures 7mm. The mucous membrane of the calyces, pelvis.and ureter is smooth and rede prominently from the medulla. The tissue shows no evidence of pathologic change. The tissue cuts with usual'resistance and on section the cortex stands out The left kidney weighs 35.3gms. The capsule strips with ease leaving a smooth surface*7 URINARY BLADDER The wall of the urinary bladder measures 4nmm. in thickness. The lumen is The mucous membrane is intact, patent, and on section the normal architecture is maintained. The prostatic urethra is The prostate measures 22mm. by22mme by 111cm. The tissue cuts with usual resistance PROSTATE The testes and epididymides cut with usual resistance and on sectiqn,shows no evidence TESTES AND EPIDIDYMIDES of pathologic chan e. (Oae additional aheets of tIlia.form (Standard Form 502) il more apace is required) _ SIGNATURE OF PH.YSIGIAN DATE IDENTIFICATION NO. I ORGANIZATION rAT16NT'S IDEKTiFICATION (Pbr t7Qed or wrilt.n enjFie. /i.s.N.+m.-l.at, Rrat, ! REGISTER NO.' ' WARD NO. middl.: Irad.,-d.t.; aosd!laZor madic.LlarilitY) ' ' Dog 5209

lfaeelard Iane 302 Rw. Augml 195A {uroau of Ifio ludyet Girculor A-32 •a: '11; 1 4111; C3a CLINICAL RECORD I NARRATIVE SUMMARY Dog 5209 DATE OF ADM1551ON I DATE OF DISCHARGE a asslsc.l_~ - lSijn The testes string easily. GASTROINTESTINAL TRACT The mucous membrane of the hypopharynx is smooth. ESOPHAGUS - I .•The mucous membrane of the esophagus is smooth ancd grey, .''are prominent. STOMACH u.:. aorr.arcnr rer~.mrc orncc ~ NUM9ER OF DAYS HOSPITALIZED '' Page 6 The longitudinal folds The mucous membrane of the stomach is intact ana 13 brown in appearance. DUODENUM The mucous membrane is intact and brown in appeara•ace. JEJUNUM The mucous membrane is intact and brown in appeara:zce. The villi are prominent. The cecum measures 8cm. 'The mucous membrane is intacta It cuts with usual resistance. COLON mucous membrane of the transverse colon is intact 3nd brown in appearance. The mucous membrane of the descending colon and sigmoid colon is intact and brown in appearance. The rectum is smooth. The anus is grey-white in appearance and is smooth. .The mucous membrane of the ascending colon is inta:~t and brown in appearance. The The pancreas weighs 27.7gms. The tissue cuts wit:1 usual resistance. The normal architecture is maintained and shows no evidence oE pathologic change. (Use additional sheets of this form (Standard Form 502) if more space is required) SiGNATURE OF PHX5ICIAN I DATE IDENTIF1c:AT1ON NO.' ORGANIZATION 4 PATIENT'S /DENSiFICATION (For typ ed or wr{ttaa.en jf iea di.a; lYamo-laat, hnt, middl.; /rada; -dat.L6oapiGeYor atediqa7laeility) Dog 5209 NARRATIVE SUMMARY 8taadard Form 02 Q 502-107 ~ , ~:x.

e Stand.rd Ieres 502 R... Aaqust 1954 lur.au ofthf ludgel arNlor A-32 CLiNICAL RECORD ( DATE OF ADMISSION NARRATIVE SUMMARY DIAGNOSES Thrombus of the right auricular appendage /~ tr- ,:qc'. . W' U}~ Dog 5209 Pulmonary emboli, left diaphragmatic lobe, questionable to other lobes. Pulmonary infarcts, recent ~ Bottle A - Bottle B - Bottle C - Bottle D - Bottle E - Bottle F - two sections two sections two sections two sections two sections two sections Bottle G - two sections left apical ~lobe left cardiac lobe left diaphragmatic lobe right apical lobe right cardiac lobe right intermediate lobe right diaphragmatic lobe (Uae additional sheets of this form (Standard Form 502) if more space is required) ft SIGNATURE OF PIiYSlC1AN ~ pATE ' IDENTIFlCAT1ON NO. I ORGANIZATION PATIENT's IDENTIFICATION (For typd d or wjitNn..nJjisa/irs•Xaafa-laat,lfrat, anidd/a: /rad*t datat hosnitaor madiul t~cililr)

, SlLtedr/d rarm 302 Rar. Aoqon 1954 tunw sf ffi. iodqa QR71ae A-32 CLINICAL RECORD I DATE OF ADMISSION I DATE OF DISCHARGE Y.S. 60tLa:rLUi r41MI1M6 OrrICC <l.l-14--/1413-1 4OS-uiy NARRATIVE SUMMARY Dog 5209- ' NUMBER OF DAYS HOSAITALIZED /{' Page 8 , .. _ (5itn ari a e ~'IIfnaT!''d'C7•erj-! 1LA1 & 1LA2 & LA5 LEFT APICAL LOBE The capillaries of the interstitial tissue are modarately dilated and filled with ~lood. 'The walls of the alveolar septa, particularly in the subpleural regions of the lobe, are slightly to modera ely thickened by collagen fibrils, fibroblasts and histiocytes. Izi the areas just~beyond these the alveolar septa are torn to cells. The elastic framework of the lung parench-Ima is maintained. arteries contain thrombi composed of red blood ce:Lls, a few neutrophils and mononuclear cells. The interlobular septa are ed,ematous and contain mononuclear The elastica van Gieson stain shows the elastic f:.bers intact at the pleuropulmonary junction. The overlying pleura is slightly thickened by an increase of connective tissue. The internal elastic lamina of the arter:Les is intact. The walls are of average thickness. The overlying pleura is sligh:ly thickened by an increase of connective tissue. Some of the branches of the pulmonary arterioles and small DIAGNOSES 1. Pulmonary fibrosis and emphysema, slight to moderate . Basal cell hyperplasia, slight to moderate, with slight to moderate atypism 5. Fibrous thickening of the pleura, slight 2LC1 & 2LC2 & LC1 LEFT CARDIAC LOBE The walls of the alveolar septa, particularly in the subpleural regions, are slightly (Use additional slleets of this form (Standard Form 502) if more space is required) histiocytes, collagen fibrils, brown pigment and z•ccumulations of fat. The overlyin pleura is slightly thickened by an increase of connective tissue. cells and show a slight increase in the number of bas•al cells,the nuclei of.which vary slightly in size, shape and staining character. In areas within the lung parenchyma there are occasional smaljl oval and roc.nd foci composed of fibroblasts, arteries are of average thickness. The bronchi 'are lined by tall columnar epithelial ;-+ :,:.are very slightly thickened by pink hyaline material. Branches of the pulmonary ~ leave slightly to moderately enlarg d air sacs.. Branches of the pulmonary arterioles SIGIVATURfE OF 97iY8tCLW I DATE IDENT1Ff,:ATION NO. I ORGAIVIZATION ER NO. PATIENT'S IDEIVTiFICATION (For typed or written entries qire: Name-laaf, Brst. - [75T middle; Jrade; date: hospita/or medical facility)

sM1ea/Q rmn so] Ret. Auqot,t 1954 sVOttV 'd the iVdyM arc0les A-Jx CLINICAL RECORD DATE OF ADM18S1ON I DATE OF DISCHARGE Dog 5209 i NUMBER OF OAYS HOSP{TALIZEO Page 9 '(Si`n and date at en o narnrn e J'~ to moderately thickened by an increase of collagen fibrils, fibroblasts and histiocytes. In the areas beyond these the alveolar septa are torn to leave enlarged air sacs. Present within the lung parenchyma is a moderate number of small oval and round foci composed of fibroblasts, histiocytes, collagen fibrils, brown pigment and fat. The bronchi are lined by tall ciliated c~lumnar epithelial cells and show a slight to moderate increase in'the number of b4sal cells, the nuclei of which vary slightly to moderately in size, shape and staining character. The capillaries of the inter- stitial tissue are moderately dilated and filled with blood. Within the alveoli in some regions are accumulations of serum. Lying in the lumens of some of the pulmonary arterioles are blood clots composed of red blood cells, neutrophils and mononuclear cells. The arteries ~re of average thickness. In areas within the lung the alveoli contain accumulation of serum and occasional alveolar phagocytes. In Slide LC1 the areas of fibrosis and the ruptured alveolar septa are slightly . more advanced than those in Slides 2LC1 & 2LC2. The overlying pleura is slightly to moderately thickened by pink hyaline material. Present within the lumens of many of the alveoli are accumulations of serum, neutrophils and alveolar phagocytes. The lumens of some of the bronchi contain neutrophils and desquamated epithelial cells. The elastica van Gieson stain shows the elastic fibers intact at the pleuropulmonary , Aunction. The overlying pleura is slightly to moderately thickened by an increase of connective tissue. The internal elastic lamina of the arteries is intact. The walls are of average thickness. The elastic framework of the lung parenchyma is maintained. DIAGNOSES Pulmonary fibrosis and emphysema, slight to moderate Basal cell hyperplasia, slight to moderate, with slight to moderate atypism Edema and congestion Acute bronchitis b .. . , - Bronchopneumonia, recent ' 7. Fibrous thickening of the pleura, slight (Use additional sheets of this form (Standard Form 502) if more space is required) SIGNATURE,OF rF1YSICIAN DATE IDENTIFICATION NO. I ORGANIZATION rAT1ENT'S IDENTIFICATICN (For typed or written sntries give: Neme-last, Aret-t a7iddle; lrad~; date: hospital or medice! tacility) Dog 5209 u.''. GOY.N.1'J1I.1,4TIrf. eFrlG4 c1:c 'Ir.•S1Yri. ; 40G Jr•! NARRATIVE SUMMARY

ilsnLaFd Tnm 302 Rs. Aoqar 1934 Ranas of fbs IWdqal CRt01e- A-32 eea•-Ib--xlo"-1 +aa u79 CLlMCAL RECORD I NARRATIVE SUMMARY Dog 5209 DA=E OF ADMISSION I DASE OF DISCHARGE 3LD1 & 3LD2 & LD11 & LD32 & LD56 LEFT DIAPHRAGMAT'CC LOBE ;-~ I NUMBER OF DAYS HOSPITAI.IZED Page 10 Al (.St~tlll~i'YY'T~ff'd'Dl HQfTf17Ir}" -'~- . , contain nuclear fragments. The forAer structure 3f the lung parenchyma is still blood cells and nuclear fragments. The walls of the alveolar septa in these regions Within these necrotic areas there is an alveolar Eilling process composed of red LD32 & LD56 are foci of varying size having a:)ink granular appearance (necrosis). The pulmonary arteries are of average thickness;- Present within Slide 3LD1, 3LD2 air sacs. The pulmonary arterioles are slightly thickened by pink hyaline material. areas beyond these 'the alveolar se~ta are torn to leave slightly to moderately enlarged blood. The walls of the alveolar septa, particularly in the subpleural regions, are slightly to moderately thicken by an increa:3e of connective tissue. In the The capillaries of the intetstitial tissue are mo-ierately dilated and filled with discernible within some of these areas. Lying-in the lumens of some of the bronchioles and bronchi in the areas beyond the infarcted areas are accumulations of neutrophil-s and desquamated epithelial cells. In the interveaing areas the alveoli contain serum, red blood cells and a preponderance of neutrophils. The bronchi are lined by tall columnar epithelial cells and show a sligat to moderate increase in the number'of basal cells, the nuclei of these vary slightly to moderately in size, shape and staining character.. Lying in the lumens of some of the pulmonary arterioles and pulmonary arteries are thrombi composed of rei blood cells, serum, neutrophils and mononuclear cells. In Slide LD11, the walls of the alveolar septa are slightly to moderately thickened by an increase of connective tissue. The tearing of the alveolar septa is present to a greater degree and the enlarged air sacs are greater than those seen in 3LD1 & 3LD2. Most of the tissue in Slide LD32 is occupied by the infarct. are of average thickness. still discernible. The internal elastic lamina of the arteries is intact. The walls tissue. Within the necrotic zones the elastic framework of the lung parenchyma is junction. Z;he overlying pleura is sliglitly thickened by an increase of connective The elastica van Gieson stain shows the.;elastic fibers intact at the pleuropulmonary Pulmonary fibrosis and emphysema, slight to moderate DIAGNOSES (Use additional sheets of this form (5tandard Foral 502) if more space is requited) IIIGNATURE OF rHYS1G7AN I DATE U.I. OOYqAt.9* r1191156 YrrIOc 10 ENTIF ICATION NO. I ORGAPlI7ATtON t'ATIENT'S IDENTIFICJlT10N (For tFpad or written .ntrisa Sir.: Nem.-leat,Brat, -~ I REGISTER NO. middle: ,rade; date: ho80tal or medical laciUty) NARRATIYE SU69MARY etanaarn 71orm ao" ' ~`~