Document nmQ86qyb7Yx7Bmm4x33NXvD5z

CO M M ISSIO N ER S JEWELL W. SWOFFRD CH A IR M A N JOHN M. MORIN JOHN J . KEEGAN OFFICIAL CORRESPONDENCE SHOULD BE ADDRESSED TO THE DEPUTY COMMISSIONER Un it e d St a t e s Empl o y e e s ' Co mpe n s a t io n Co mmis s io n LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT FOURTH COMPENSATION DISTRICT ""Roe'.roerrasromr.FsimBirs* 1261 Ca lv e rt Bldg BALTIMORE, MARYLAND E. V. PARKER De pu t y c o m m is s io n e r In reply rejet toFile No. -35b--1042 May 4 , 1943* Dr. Bobe rt A. Ke ho e , D ire c to r, Ke tte rin g Labo rato ry o f Ap p lie d Ph y s io lo gy , Un iv e rs ity o f Ci n c i n n a t i , Ci n c i n n a t i , Ohio Dear Dr. Ke hoe t I am -w riting you again -with re fe re n ce to th e cas e o f Warren No fs in g e r, i n w hich you re vie w e d th e re co rd a t ray re que s t and s e nt me your o p in io n under d ate o f Ap r il 1 7 , 1943 Aft e r re c e iv in g your re p o rt I forw arde d a co py th e re o f to Dr. No fs in ge r fo r h is in fo rm atio n . In se nding th e re p o rt to him I t o l d him t h a t i f he w ishe d I would acco rd him th e p r i v i l e g e o f t e s t i fy i n g a g a in , or th a t he h im s e lf co u ld send th e re cord to any other s p e c ia lis t or au th o rity in th e fi e l d o f metal poison in gs fo r a fu rth e r o p in io n , w hich I would be glad to co n s id e r. Dr. No fs in ge r has now re p lie d to ray l e t t e r , s t a t i n g t h a t he does not thin k i t is ne ce ssary fo r any fu rth e r m edical o pinion or te s tim o n y to be g iv e n . I am e n c lo s in g he re w ith a copy o f Dr. No f- s i n g e r 's l e t t e r to me under date o f Ap r il 3 0 , 1 9 4 3 . *ou w i l l no te that in h is p o in t No . 2 he re fe rs to the fa c t th a t you were not aware th a t th e blo o d smear w hich co n tain e d th e l a r g e s t number o f s tip p le d c e l l s was mads w ithin, s i x t y minute s a ft e r th e f i r s t hemorrhage, and s t a t e s th a t t h i s would be to o s h o rt a pe rio d o f tim e fo r th e bone marrow to thro w o ut such a la r g e number o f s tip p le d c e lls Of co u rs e , t h i s state m e nt was n o t i n th e re co rd , s in ce Mr Bo use , a tto rn e y fo r th e Bethlehem St e e l Company, and m y s e lf, who were th e onljy ones as kin g q u e s tio n s , as laymen, did no t know enough to make any in q u ir ie s alo n g t h i s l i n e ; and Dr. No fs in ge r e v id e n tly o ve rlo o ke d m e ntio ning i t . I do n o t know what w e ight you would give to th is fa c t or whethe r i t would in flu e n ce to any e xte n t th e o p in io n w hich you e xpre sse d How e v e r, in o rde r to be emine ntljr f a i r , I info rm e d Mr. Rouse t h a t I would se nd you a copy o f Dr* No fs in ge r fs l e t t e r and as k i f . you would be good enough t o comment fu rth e r upon t h i s po in t Al s o , s in ce I am as k in g yo u t h i s q u e s tio n , I would ap p re ciate i t i f you would be good enough to answer ano the r qu e s tio n o f min in co nne ctio n w ith your re port In Paragraph No , 3 o f your con o lusio ns you s ta te as fo llo w s t "Assuming t h a t th e le a d e xposure was s i g n i fi c a n t - th e d i s a b i l i t y from th a t a lo n e , o r i n co mbination N19449 Dr Bobe rt A. Kehoe -2 - Mfigr 4 , 1943. m t h exposure to z i n c , would n o t have exceeded lg b t weeks in a case s uch a s t h i s in W a S o n ! " "* 8 "e ithe r " > r e b r a l xn- from th e s e by th iE t h a t y u Vi u ld e xpe ct h is caus e s to have la s te d from fo u r to d is a b ility fo r e ight walks f work th e i h .s t o p ed TOrk fo llo w in g h is l a s t employment on the ye s s e l on w hich he had been engaged in burning pain t for tthhooufrgiht occuarsb tUot m ne*e. mI af tht h?is Amlsaon *hsaHs tai laymani, t. h 7i s rfaur,thneerr which he de s cribe d fo r a p e rio d o f "our o r p la i n t s and symptoms p ricr to h i. sto p p in g "^ * t Z e L -u " m d SUih illne? m s " industrial O M booanso of sino fume fe v e r perhaps combined w ith some s l i g h t ewnoRu^o +_ . u i t lik s ly or probable that th is 1 W I L S S d or W e i* Se n8 ral d th *> ^ a t .from. i sue h . t a h d ^ i i T X rhaged a t the . time ist wdidyfsoa" cth aSt i t~ i sa l i kae ly i st wSould~ahaTOi s . happened a t t h a t tim e e ven i f the men ha* ha* , . from me tal fhm e s, o r would such ? had^no pre vio us i l l n e s s to the e xte n t th a t i t i s nrohnhi *, i end bo low e r h is re s is ta n c e rhagad ,,h e r h9"~ - tim , o S a t L n f orSt r L t0 mU011 0 i ^ Thanking you fo r your p a tien ce and a s s is ta n c e , I am Very tr u ly yojars * {A/ E. V. Parker, Deputy Commissioner. EVPiE Enc. Copy t o z- Jobh G. Rouse, J r ., Eaq., Maryland Trust B u ild in g ,* B altim ore, Maryland. HS 0016755 - ' U Bi % 41! Bel COPY LEWIS-SLE HOSPITAL fioanoke, Virg in ia April 30, 143. Mr. E. V* Parke r, Deputy Commissioner, 1261 Ca lv e rt Bu ild in g , Ba ltim o re , Maryland. Dear Mr. Parke rs I received your le t te r o f r i l 2 4 . including the report o f Dr. Kehoe in th e cas e o f Dr. Kehoe i s an e x c e lle n t man and a re co gn ize d a u th o rity in ce rta in f i e l d s . Afte r re vie w ing h is re p o rt, I pro bably would have give n a s im ilar one as Dr. Ke ho e *s , s in ce h is re p o rt was compile d from a c l i n i c a l cas e re co rd } how eve r, a ft e r a c t u a lly t r e a t i n g a p a tie n t from th e be gin n in g and througho ut h is Il l n e s s , th e re are many fa c to rs pre s e n t w hich would e nable one to a rriv e a t a more co rre ct d e c is io n , and t h i s fa c t was a ls o mentioned in Dr. Ke hoe 's r e p o r t . One who re vie w s a c l i n i c a l re co rd in re gard to a p a tie n t's i lln e s s cannot as a ru le e valuate the fin d in gs as w e ll as th e in d iv id u a l who a c t u a l l y tre a te d the p a tie n t and obse rve d him darin g h is illn e ss. ' ' In Dr. Ke hOe 's r e p o r t , th e re are s e ve ra l p o in ts which I would l i k e to discuss* / , : . ;.., ' - - .. - 1 . In th e f i r s t in s ta n c e , he admits th a t in itia l illne ss' > was due c h i e fl y to z in c fume s; how eve r, le ad fumes might have be e n pre se nt. ' . . ... . ; ; V- i i:.;, . ; i;;/ y ; 2 . In the se cond in s t a n c e , i t was Dr. Ke ho e 's o pinio n t h a t the - s tip p le d e ryth ro cyte s re s u lte d from th e he morrhage . In t h i s i n s t a n c e ,> Dr . Ke hoe was no t aware o f th e fa c t t h a t the blo o d smear w hich co ntaine d th e l a r g e s t number o f s tip p le d c e l l s was made w ith in s ix ty - xldnut8 !iaiiter.% ; : -. the f i r s t hemorrhage , and t h i s would be too s h o rt a pe rio d o f t im e ;fo r th e bone marrow to throw o ut s uch a la rg e number o f s tip p le d c e l l s . - I would `V a ls o li k e to s t a t e th a t I have se e n !q u ite a nuaiber o f cas e s o f s e ve re he morrhage, in clu d in g hemorrhage from a duo de nal,u l c e r , and in none o f. th e s e cas e s have I e ve r s e e n a s tip p le d c e l l co unt whieh exce eded 1 1 ,0 0 0 w hich was the s i t u a t i o n in Warre n's ca s e * :. r l- -r. 3 . As to the o r i g i n o f th e duodenal u lc e r and th e s o urce o f th e hemorrhage in t h is in s t a n c e , I tho ro ughly agre e w ith Dr. Ke hoe j as was s ta te d in my te s tim o n y . I t was my im pre s s io n t h a t Warren undo ubte dly . had an in a c t i v e duodenal u lc e r b e fo re t h i s i l l n e s s , and th e hemorrhage was from the duodenal u l c e r . I t was a ls o my Im pre ssion th a t th e duodenal u lce r was in a c tiv e b e fo re t h i s i l l n e s s and the i n i t i a l i l l n e s s cause d by th e m e tal fumes aggravate d th e u lc e r re nde ring i t more a c t i v e , thus /&'$> ,, :jl i - y - * . , . . f - ' <| V,1*! i, I , ' '. * - - ** , *' - 2- us ing th e he morrhage. I t i s p e r fe c t ly tru e that i n many in s tan ce s o f a c t i ve duodenal u l c e r , a hemorrhage w i l l results however, ju s t prxor H-m Um i l l n e s s , h e ,appare n tly 'was having no symptoms re fe ra b le to u lc e r and du rin g th e co urs e o f the Il l n e s s cause hy me tal fum e s , he de ve lope d the hemorrhage . I t would then he re aso nable to assume th a t h is i n i t i a l i l l n e s s , caused by m e tal fumes, aggravate d the u lce r w hich re s u lte d in he morrhage, s in ce a to xe m ia from such me tal fumes would be capable o f aggravating sduodenal ulce r In co nclus io n , due t o m e tal fummeess., fumes were z in c or it is aanndd' i le ad } . quite evid t .would be --however, I ent of am that little s till fiJlllilil i;n "d ifflb te h ;c e o f the same i tia l ill whether opinion n e s s was th e s e th, a,,t i l-e-a--d was pre s e nt and th a t h is i n i t i a l i l l n e s s aggravate d an o la duodenal u l c e r , w hich re s u lte d in a hemorrhage. In c a s e , Ix doo n o t th in k i t i s n e ce s s ary to o ffe r any fu rth e r m e t i e r t e s t lo o n y , and we are le a v in g th e d e cis io n to your judgm e nt. Sho uld you be in Roanoke a t any tim e , p le as e drop in to se e u s . Sin ce re ly yours, ( Sign e d ) . C. D. No fs in g e r , M.D. c m :K 0016*57