220 
September 17, 1972 
Dr. Arlghl 
French Hospital 
Port Vila, Efate 
New Hebrides 
Dear Dr. Arlghl: 
John Makall, a 59 year old male from Makatea village, Emal, who was in our 
study of that village 8 years ago, has arrived to complain of shortness of 
breath on exertion and no other symptoms. On examination he has flatness over 
the right lower lobe, anteriorly, and dullness extending laterally to the mid 
axillary line. He has Increased tactile fremitus and depressed breath sounds 
over the right anterior and lateral chest and some limitation of movement of the 
right chest wall in breathing. His signs include moist rales over this lobe and 
laterally. This suggests a pleural effusion and consolidation in the RLL. 
On later questioning the patient reveals he has been a long time in-patient 
in the French Hospital on treatment which sounds as though it were 
anti-tubercular. We have told him to return to see you for new x-ray studies 
and possible treatment of a recrudescence, should your studies warrant this. 
Sincerely, 
D. Carleton Gajdusek, M.D 
