Document M4KeJ5QN7qrBJB1X88a3RGnOa

am o p Bevtev end Opinion VS STEEL 00 Prom the testimony of the claimant, end from the facte elicited from other concerning me nature sad duration of the cleisaant's vork there seems little doubt that' his initial illness arose out of Ms employment and ms in fact sensed by it* The medi cal question at issue therefore are concerned vith (1) the causative factor or factors of the employment that caused the initial illness. and {2} the relationship, if any, betveen the occupational illness ' and the occurrence of the duodenal ulcer shim# no doubt, gave.rise to the hemorrhage and prolonged the disability* 1. The primary illness The original complaints coincide vith the vell-known effects of the inhalation of fumes fro--overheated galvanised surfaces, the .. so-called line chills,11 and the history of employment is such as to justify the belief that this type of industrial intoxication existed* The occurrence of significant lead exposure in the course of this sssn*s vork has not been established vith reasonable certainty. Undoubtedly there va son lead exposure in the course of burning lead-coated metal sheets and plates. It is veil fcnovn that exposure to lead fuses originating in this moaner, under conditions in vhich the vorfcaten are inadequately protected, is one of the most serious of the lead hazards la industry. The severity of the exposure and its duration in this case, cannot veil be judged from the available information. The testimony of the claimant is not definite as to the length or periodicity of the vork vith painted surfaces or as to the extent to vhleh he protected himself by the use of a mask, and no KV 0016765 other evidence has been submitted to indicate whether this employee or others who carried on simile* work on the ship la question absorbed significant or dangerous amounts of lead. It is suggested by certain statbBidSa: *flr-^Wltbussfs ;that' serious oases ' of" WmM poisoning'had not occurred; ipNni. the. workmen s employed- by IMS defendant* -Against a too;.easy!'iscce^teice' of the conclusion' is the knowledge of this r* viewer thatunder certain conditions # irork of similar type can and does cause serious and even fatal lead intoxication. - One can only conclude that the evidence presented' concerning the occupational car* ditioas la, this case is not adequate to Justify a decision as to the l^iifl^sice of the lead exposure. no analytical data on the blood or excreta of the claimant are available to ahov that he absorbed significant quantities of lead* Granting that the white precipitate obtained in the chemical anslyeis of the urine as described in the report frees the laboratory, ms lead sulphate, (this cannot be accepted with certainty) there is still np evidence to Indicate that the quantity of lead in the urine m ab normal, unusual, or in any my indicative of hazardous lead exposure. It follows from thess facts that Judgment concerning the existence or non*existence of lead poisoning in any period of the claimant 's illness rests solely upon clinical Interpretation of the nature of his Illness, the type of Illness end Its course were not' such as to Justify a diagnosis of lead poisoning. Every early symp tom described can more readily be explained as an effect of exposure to sins fuses, fhe symptoms present after the first hemorrhage oc curred are more plausibly to be attributed to the duodenal uleer later shorn to be present, than to the effects of lead, the presence KET 0016766 of vtiic^h is uncertain. It is possible that there wore certain other uadeaerlbed clinical features of the ease that argued for lead a a . causative factor in the mind of Dr. Hofsinger# but there is nothing in his 'tsttlsihisy :#ftt gives convincing or mm strongly sug8Uve : . videae to list effect.. fh only point mad that merit detailed dteeue&ien is that of the sloroeoopie changes .In . the blood* specifi cally the stippling of the erythrocytes. Accepting the laboratory report at its face vain# to the effect that the stippled erythrocytes wen sore fusaerous than the. leucocytes in the early examination # (greater assurance would he felt on this point if an actual count of the stippled erythrocytes had been made)# there i still no evidence of lead absorption, This mn had a sever honerobagt and the condi tion vere ri#it for the pouring out of large numbers of Immature erythrocytes# provided he had a nonsally active bone narrow. That he had such a responsive bone narrow is shown by the satisfactory increase in the erythrocyte count as noted on successive blood examinations. It has been established beyond peradverture# that increased numbers of stippled erythrocytes are found regularly in secondary anemias and in most oases In which blood destruction occurs in the absence of injury to the bone marrow. The numbers rou^Oy estimated as being present in this- case are sot unusual or nesarkabl# if the seriousness of the hQn?bsge ;ia considered. Thus the stippling can be explained entirely by the hemorrhages# and there is no evidence to indicate that any other explanation or supposition is warranted* There is m slight point of contradiction In the testimony# In that the claimant speaks of hemorrhage from the mouth# while th physician (Dr. Hofsinger) describes evacuation of blood Tram the bowel. KE 0016767 this apparent contradiction Is beet resolved by assuming that both actually occurred. This ie compatible with the existence of duodenal alow as the soupee of the hemorrhage. Any can# fop the hemorrhage other than tho duodenal ulcer would he based a pare speculation and is wholly unjustified on the basis of the nodical testimony* Hemorrhage from the stomach, Intestine, or bowel would be aa exceedingly ques* ' ticaable part of the picture of lead poisoning, sad la this case, no such blsim6.explanation of it is required# There is little or ao reason to suppose that the relatively short exposure to sine fumes would have caused prolonged disability, and there is so medical evidence with which this reviewer Is &* quainted, that would warrant the belief that such exposure is likely to cause duodenal ulcer or to. produce. exacerbation of a en^scent duo* deaal ulcer* Mo causal relationship between duodenal ulcer and lead absorption can be seriously considered, nor can hemorrhage frost such an ulcer be attributed reasonably to the effects of lead. In fact there is no sound reason to suppose that this was not duodenal ulcer of a common typo. Hemorrhage fro such an uleer is not of Infrequent occurrence, nor was there any unusual feature in this case when it is reviewed In that light. Conclusions . My opinion is stMMirlsed as.follows! (1) fh# claimant was exposed to metal fusses, chiefly those of sine in burning galvanised metal In sufficient concentration to Induce typical effects in the foref of laetal fume fever. (2) There say have been significant exposure to lead cost* pounds as the result of burning metal surfaces heavily coated with KE 0016768 . ;'.V ' " V paint, but evidence of the occurrence of such exposure is lacking both in the occupational history and in the clinical pattern of the 4 lHaeaa. ' -? (y) fhe disability resulting from exposure to metal fissts me of slight to moderate severity and vbald bo' expected to be i a- ir.K .v - ' *' of brief tootles* Assuming thatthe lead exposure ms significant i%-- 4 the disability fkwrthat-aan* or in co^jia&tioa with exposure to else -maid sot have exceeded four to eight ;vNleiai: is'' caae such as .,'V* this in which there was neither paralysis or cerebral Intoxication* * (4) Kio disability of^ the claimant over the" period of . months, sad the large bulk of the medical care required by him during his illness resulted from hemorrhage duo to duodenal ulcer. Neither * -j - the ulcer aor the hemorrhage is attributed to tli effects of sxposur t to metal fusses* . .' Slimed* fio Krt t ; mho-siTrrg:-- April IT# 19*2 ij 1 ,: : - \i--iAri =-.5 f':T-=r'-'~\ = C, ; ':Si4. KE 0016769 ,