Document O1ydvOQdJMBNpEVkyzzxeoR5j

%r. Donald M. MscCready ftorkman' s Compensation Board Sta ta Offi o Bu ild in g Albany 1 Sew York Re t So . S42Q4741 Claim an t t Sn plo ye rt oweT5 ^TT Co .* la c * Be ar Mr. MacCreadyt At your re que ste d I comp le te d the im p a rtia l e xam inatio n on the above claim ant o n Octo be r I S , 1947. i s 47 ye ars o f age and m arrie d. His c h i e f co m plaint was extre me s ho rtne s s o f bre ath and p a in in th e ch e s t on s l i g h t e x e rtio n fo r the p a s t fi v e ye ars * However* t h is has improved during the pas t fi v e months , HISTOBY OF PRESEST JLLS&8 S* He was w e ll u n t i l Ju l y , 1042. During th a t month he began t o n o tice Mis s y s p e lls '* w hile d riv in g a tank truck fo r th e Sh e ll O i l Company* These s p e lls fo rce d hi to p u ll o ve r to the s id e o f th ro ad , and la s te d fo r a fe w minute s* He m s the n able to co n tin u e . At no time d id he lo s e co n s o io us ae s s * the s e s p e l l s became c lo s e r to ge th e r u n t i l Se pte mbe r, 1942, whan he c a lle d in Dr. Tiilliam Capovrski o f Milto n , Sew Yo rk, who to ld him to s to p w ork. Dr. Capowsld was c a lle d be cause Mr. Mille r "passe d o u t" a t home w hile r e s t i n g . Aft e r Dr. Capow ski' a e xam inatio n he was re fe rre d to Dr. Fe rgu s o n in Mewburgh fo r a card iac e xam in atio n , and i t i s Mr. f ^ m ^ s t a t e s e n t th a t D r. Fe rguson advis e d him to r e s t fo r a t l e a s t a month o r s i x w e e ks. Bu rin g the n e xt fi v e w e e ks, even though he d id a c t work, and e ve n though he re s te d co n tin u o us ly he became more dyspne io and l o s t w e igh t, be cause o f t h i s he was s e n t to Ys s s a r Bro the rs Ho s p ita l where Dr. Capowski d id a comple te work-up w itho ut a rr iv in g a t any d ia g n o s is . l a March, 1943 he de ve lope d a s e ve re s o re t h r o a t , whioh was diagno se d as a s tre p to co ccu s t h r o a t , and a t t h a t tim e he changed d o c to rs , tr a n s fe rr in g h is e&se to B r . Ca r l Maakias o f High lan d . Dr. Meekins tre a te d him fo r vario u s g a s t r i c a n d ch e at,co m p lain ts w itho ut g iv in g him any d ia g n o a is . A pe ptlQ u lc e r was s us pe o te d a t t h a t time but was n o t proven* In September* 194$ he was t o l d i t he had a s t Ma and was advis e d to go w e s t. Me went t o Ca l l fo r n i a and h ia co n d itio n th e re did no t improve , i n fa c t he fe lts i t was w o rs e , and he came hem. Tvhile i n Ca l i fo r n i a he a t tempted t o do a co uple o f days o f work fo r an a irp la n e fa c to ry bu t was un a b le to c e n tim e * On h is re tu rn from Ca l i fo r n i a he was to ld to r e s t as much as p o s s ib le and not to do any w ork. In Fe bruary* 1944 he changed from D r. Se e king t o Dr. Blake le y i n High lan d . Dr. Blake le y has tre a te d him s in c e fo r a "ca rd ia c co n d itio n " and "s p le n ic d i s e a s e ." ' 0004685 N 7141 c 2* Octo be r 2 7 , l4 7 Mr ^ ^ P ^ ^ ^ o rk e d fo r nine and a h a l f ye ars as a drive r-s ale sxnan on a gas o lin e truck owned by the Sh e ll Oi l Company. His work co m i s te d o f d e liv e rin g ga s o lin e t o vario us oustomere and a t time s re quire d fo urte e n o r s ix te e n hours o f work a d a y. The trucks had c a p a c it ie s v a ry in g from 2 ,1 0 0 to 3 ,6 0 0 g a llo n s . These trucks had to be f i l l e d fo u r to fi v e tim e s a day in an open s h e d , but the p a tie n t claim s t o have inhale d fumes w hich co ntaine d t e t r a e th y l le a d . At th e pre s e nt time he i s s e v e re ly dygpne ic oh the s l i g h t e s t e x e r tio n . He sometimes has c h e s t pain fo llo w in g e x e r tio n , re lie v e d by r e s t . Tic i s d e fin i t e l y or the panic and needs fo u r p illo w s a t n ig h t fo r co m fo rt. lie a ls o com plain s o f pain in the l e ft upper quadrant. PAST HISTORYt Hr. t ^ 0 | ^ e l a i m s t h a t he was i n good h e a lth e xce pt fo r an a tta ck o f lo bar pneumonia i n 1S41 . P h y s ic a l e xam ination on Octobe r 1 6 , 1047 re ve ale d a dyspne io m ale . P ild oyan os i s o f th e m alar are as and o f the l i p s . Dila te d ve nule s on th e nos. S l i g h t oyanosis o f the n a il beds* Sye aj Pu p ils re a c t to l i g h t and accosuaodatiou. Eye grounds 3how m ild s c l e r o t i c ahangs and t o r t u o s i t y . Tongue i s c e a te d . Throat i s n o t i n je c t e d . The ch e s t i s emphysematous l a ch a ra c te r. Thar i s an incre as e d an te ro po s t e r io r d iam e te r. ' the e xcu rs io n i s s ym m e trical w ith bre athin g mos cly by means o f the accessory musales o f re s p ira tio n . The h e art i s n o t e nlarge d to p e rcu s s io n . The sounds are m uffle d and d i s t a n t and o f o n ly f a i r q u a l i t y . Re gular i n r a t a , lb ro e and rhythm. There are no murmurs. 8- p. 116/ 80. Abdomen shows n o m o s s e s and s l i g h t te nde rne ss i n th e l e f t upper quadrant. There i s a s m all r ig h t in gu in a l h e rn ia . . ` Se u ro lo gic a l e xam inatio n i s normal, and. th e re Is no edema o f the e x tre m itie s . 0004686 Flu o ro s co p ic e xamination re ve ale d the ca rd ia c shadow to be o f normal s iz e w ith some incre as e d rounding o f'.t h e --le ft lower bo rde r. The o o rdio tho rao io r a t i o was no rm al. There was impaire d motion o f the r i g h t l e a f o f the diaphragm, some in cre as e d b ro n ch ia l markings o n both s i d e s , and iacr&Haad ae ratio n o f bo th b a s e s , s u gge s tin g emphysema. Ele ctro cardio gram i s e n clo s e d and shows no a x is d e v ia tio n , some s lu r r in g o f U* th e v e n t r ic u la r componenta in Lead 3 and i n th e ch e s t lo a d s . I t shows an in ve rte d ? wave i n CFj_, d ip h a s ic ? . waves i n CFg and CF-j. X-ra y re p o rts from D r . J . Spo ttis w o o d Taylo r take n on Octo be r 6 , 1647 and re po rte d by Dr. la g a l l s show the "stomach to be o f normal type and p o s itio n and w e ll o u tlin e d . So d e fo rm itie s o r f i l l i n g d e fe c ts are appare nt. P e r i s t a ls i s and rao tillits y are no rm al. The duode nal cap f i l l s w e l l . Thera i s no re te n tio n Mr. Donald K. MacCready 6, Octobe r 2 7 , 1947 a t lx hour and th e barium has made u s u a l pro gre s s * There 1 no e vide nce o f an o rganic co n d itio n o f th e s to m ach." ^ Che at* '`There ia soma h i l a r th ick e n in g w ith some acce n tu atio n o f lung m arkings. Parenchyma o f bo th lun g fi e l d s i s c l e a r . There i s no e vide nce o f p le u ra l in vo lve m e nt. The card iac shadow i s normal. There i s some lim it a t i o n o f motion o f the diaphragm. This i s somewhat store marked on the r i g h t ." A oount done on the same day a t th e Kings to n Ci t y Laboratory showed he ao glo bia o f 10^1 S o h l i , red blood o e l l s 5 ,4 1 0 ,0 0 0 , white blood o e lls Id ,O d d . The d i f fe r e n t i a l oount was n e u tro p h ilic m ye lo cyte s 4 $ , n e u tro p h ilic bona o e l l s 10/ ., polysiorphonuclaar alls 7 5 ^, polyae rpxionuclear e o s ia o p h ile s 1/ i, polymorphonu c le a r bas o p h ils 1 $ , la rge lymphocytes 4 4 , s m all lymphocytes 4ji, la r g e mono nucle ars L i . The le uco cyte s i s and th e youn g forms o n th a t ox&min&tiorx were e xp lain e d by t h e fa o t t h a t Mr. Mille r had an acute b ro n ch itis when i t was don e. Dis cu s s io n : ^ 'r .^ | H l k h a s been i l l s in ce Ju ly o f 19 42 , and has oaoa unaoie to work s in ce Je p ta a b e r^ iS4 2 * There appears to be more than one co n d itio n invo lve d i n t h is c a s e . Si s o r ig i n a l co m plaint co n s is te d o f some s o r t o f syncope o r th re a t ened s ynco pe , de s cribe d by him as a s e n s a tio n o f "fa i n t i n g o r pas s in g c u e ." Ap p are n tly h a made no me ntion a t t h a t time o f dyspne a o r ch e s t dis co m fo rt on e xe r t i o n . Gradually the s to ry o f dyspnea aad ch e s t d i s t r e s s e n te rs t h e p io tu re , b u t from the re co rd th is appare ntly was f i r s t n o tice d two months a ft e r t h e o r ig in a l o n s e t. Ia review ing the voluminous f i l e on th is case there are c e r t a in th in gs which r em ain co n s ta n t. The apparent re s p ira to ry and ca rd ia c embarrassment has teem pre se nt on every e xam ination e xce p t the o r i g i n a l co n s u lta tio n by Dr. Fe r gus o n. There i s a d e fi n i t e change in t h e BKG from the one r e p o r t e d oy Dr. :;o lcomb, aad the .pre se nt KG agre e s i a s ubs tance w ith the one done by L-r . Fe r gu son in 1944. Im pre s s io n: I fe e l th a t Mr. a t pre se nt has a no n-valvular h e a r t d is e a s e , probably o n th e b a s is o f c o ro n aryTn s u i' f 1cie noy , myo oard i a l damage, sad i s in Cla s s I I I . He a ls o has chro n ic emphysema, the causa o f whioh i am n ot a b le to a s c e rta in from th is e xam in atio n , a p a r t i a l p a ra ly s is o f the l o f t le a f o f the d ia phragm, and a s m all r i g h t in gu in a l h e rn ia . The e xposure to t e t r a e t h y l le a d ia d i f f i c u l t t o f i t in to the p re s e n t p i c t u r e . I t i s p o s s ib le and p e r naps p r o b a b le th a t th e o r i g i n a l com plaint o f d iz z in e s s and fa i n t n e s s , a p p a r e n t ly r e la t e d to th e cerebrum were on the b a s is o f le a d e xp o s u re ,- but the re in n o t h in g in the s ucce e d in g x -r a y s , EKG*s and labo rato ry work upon whioh one ca n make a d iagn o s is o f chro n ic le ad p o is o n in g, the ca rd ia c p ictu re impre sses me as d o in g a pro gre s s i v e , de ge n e rative typ e o f i l l n e s s , whioh does n o t depend upon exposure to le a d fo r i t s o r i g i n or. i t s pro gre s s * '-v ' - Re spe ctfully submitted. RTL*ao (Sig n e d ) R . . LA.-IDU3, M.D. SJ-14Q Q 5 0004687