Document EdxVRxRbV4YnG3J0qp29zz5yx

COMMISSIONERS JEWELL W. SWOFFORD CHAIRMAN JOHN M. MORIN JOHN J. KEEGAN OFFICIAL CORRESPONDENCE SHOULD BE ADDRESSED TO THE DEPUTY COMMISSIONER Un it e d St a t e s Emp l o y e e s ' Co mp e n s at io n Co mmis s io n LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT FOURTH COMPENSATION DISTRICT --Rog.r^ss.'Tosmmce's h il t o w 1261 Calvert Bldg BALTIMORE. MARYLAND E. V. PARKER De p u t y Co mmis s io n e r In reply refer to File No. 35vtel042 May 4, 1943. Dr. Bobert A. Kehoe, Director, Kettering Laboratory of Applied Physiology, University of Cincinnati, Cincinnati, Ohio. Dear Dr. Kehoet I am writing you again with reference to the case of Warren Nofsinger, in which you reviewed the record at ray request and sent me your opinion under date of April 17, 1943. After receiving your report I forwarded a copy thereof to Dr. Nofsinger for his information. In sending the report to him I told him that if he wished I would accord him the privilege of testifying again, or that he himself could send the record to any other specialist or authority in the field of metal poison ings for a further opinion, which I would be glad to consider. Dr. Nofsinger has now replied to ray letter, stating that he does not think it is necessary for any further medical opinion or testimony to be given* I am enclosing herewith a copy of Dr. Nofsinger's letter to me under data of April 30, 1943. *ou will note that in his point No. 2 he refers to the faot that you were not aware that the blood smear which contained the largest number of stippled cells was madd within sixty minutes after the first hemorrhage, and states that this would be too short a period of time for the bone marrow to throw out such a large number of stippled cells. Of course, this statement was not in the record, since Mr. Bouse, attorney for the Bethlehem Steel Company, and myself, who were the onljy ones asking questions, as laymen, did not know enough to make any inquiries along this line? and Dr. Nofsinger evidently overlooked mentioning it. I do not know what weight you would give to this fact or whether it would influence to any extent the opinion which you expressed. How ever, in order to be eminently fair, I informed Mr. JSiouse that I would send you a copy qf Dr* Nofsinger^ letter and ask if you would be good enough to comment further upon this point. Also, since I am asking you this question, I would appreciate it if you would be good enough to answer another question of mine in connection with your report. In Paragraph No. 3 of your con clusions you state as followsc "Assuming that the lead exposure was significant N1944 Dr. Robert A. Kehoe -2~ Mey 4, 1943. -with exposure to zinc, -would not have exceeded four to eight weeks in a case such as this in. which there was neither paralysis nor cerebral in toxication." Do you mean by this that you would expect his disability for work from these causes to have lasted from four to eight weeks from the time that he stopped work following his last employment on the vessel on which he had been engaged in burning paint for a period of about one month? Also, as a laymen, this further thought occurs to mes If this man had the ooraplaints and symptoms which he described for a period of four or five weeks immediately prior to his stopping work end for some earlier intermittent periods, and such illness was an industrial one because of zino fume fever perhaps combined with some slight exposure to lead, is it likely or probable that this illness weakened or lowered the men's general resistance so that from such standpoint at least the illness hastened the hemorrhaging of the duodenal ulcer? In other words, is it only a pure coincidence that the ulcer hemor rhaged at the time it did so that it is likely it would have happeod at that time even if the man had had no previous illness: from metal fumes, or would such illness tend to lower his resistance to the extent that it is probable the ulcer would not have hemor rhaged when, it did but for the experience undergone. I trust that I may not be taking up too much of your valuable time with these further questions or trespassing upon your good nature, but you will appreciate my desire to have as much informa tion as possible in order to arrive at a fair decision. Thanking you for your patience and assistance, I am Very - E. V. Parker, Deputy Commissioner. EVPtE Ene. Copy tos Jottti G. Rouse, Jr., Esq., Maryland Trust Building, Baltimore, Maryland. HZ 0016735 LEWIS-GALE HOSPITAL fioanoke, Virginia, April 30, 1S43, I Mr. E. V* Parker, Deputy Commissioner, 1261 Calvert Building, Baltimore, Maryland. Dear Mr. Parkers I received your letter of ril 24. including the report of Dr. Kehoe in the case of Dr. Kehoe is an excellent man and a recognized authority in certain fields. After reviewing his report, I probably would have given a similar one as Dr. Kehoe*s, since his report was compiled from a clinical case record? however, after actually treating a patient from the beginning and throughout his illness, there are many factors present which would enable one to arrive at a more correct decision, and this fact was also mentioned in Dr. Kehoe's report. One who reviews a clinical record in regard to a patient's illness cannot as a rule evaluate the findings as well as the individual who actually treated the patient and observed him during his illness. In Dr. Kehde's report, there are several points which I would like to discuss* 'A:' 1. In the first instance, he admits that initial illness' > . was due chiefly to zinc fumes; however, lead fumes might have been ' ^ present. ' A- , . ;.. ;-'f/v r- 2. In the second instance, it was Dr. Kehoe's opinion that the stippled erythrocytes resulted from the hemorrhage. In this instance,> Dr. Kehoe was not aware of the fact that the blood smear which contained the largest number of stippled cells was made within sixty-. adnutM'i^effeer.-^ the first hemorrhage, and this would be too short a period of time;for the i- ' bone marrow to throw out such a large number of stippled cells. - I would ' `V also like to state that I have seen! quite a nuaiber of cases of severe . ' -. -- . hemorrhage, including hemorrhage from a duodenal ulcer, and in none of these cases have I ever seen a stippled cell count whieh exceeded 11,000 which was the situation in Warren's case. u Bi 3. As to the origin of the duodenal ulcer and the source of the hemorrhage in this instance, I thoroughly agree with Dr. Kehoe; as was % stated in my testimony. It was my impression that Warren undoubtedly n: had an inactive duodenal ulcer before this illness, and the hemorrhage Bei was from the duodenal ulcer. It was also my impression that the duodenal ulcer was inactive before this illness find the.initial illness caused by the metal fumes aggravated the ulcer rendering ,it more active, thus H* 0016736 . N19449.01 -2irfl-using the hemorrhage. It is perfectly true that in many instances of active duodenal ulcer, a hemorrhage will result; however, just prior t0^iMB:linees* he apparently was having no symptoms referable.to theSBBRSttl ulcer and during the course of the illness cause by metal, fumes, h8 developed the hemorrhage. It would then be reasonable to assume that his initial illness, caused by metal fumes, aggravated the ulcer which resulted in hemorrhage, since a toxemia from such metal fumes would be capable of aggravating aduodenal ulcer In conclusion, it is quite evident that j]. P.jUfc initial illness was due to metal fumes, .and it would be of llttle^a&fPPrgneiewhether these fumes were zino or lead; however, I am still of the same opinion that lead was present and that his initial illness aggravated an old duodenal uloer, which resulted in a hemorrhage* In case, I do not think it i s necessary to offer any further medical testimony, and we are leaving the decision to your judgment* Should you be in Roanoke at any time, please drop in to see us* Sincerely yours, (Signed).C. D Nofsinger, M*D* fj! CHI :K Ml * Kg 0016757