The National tribune., 1902-09-25

91-2 inches. Ecchymosed appearance Of
entire surface (of left leg).'
The Board further described beginning
senile cataract in each eye and reported
that the urine contained so per cent by
volume Of albumin.
at is observed that the claim was re-
Gently rejected on the same ground as
before-on the ground that the soldiers
death resulted from disease Of kidneys
not due to cause which has been legally
accepted, yet the Medical Referee states
that it is not satisfactorily shown that
the pensiOned disability was a factor in
causing the soldiers DEATH as though
not fully indOrsing that action in tho light
of all the evidence. The Department car
not agree with the conclusion that disease
of kidneys was the cause of the soldiers
death, for it is not sustained by the evi
dence and the history of :he case, espe
cially during the fatal illness. Disease OF
kidneys was Il complication, no doubt
but it is quite evident that gangrene was
the immediate cause of death.
There is no positive evidence that the
soldier suffered from disease of kidneys
for any considerable period prior to his
death. The official report in 1890 stated
that there was nothing to indicate renal
disease Nothing abnormal about the uri-
nary organs was shown i'll 1881. In 1886
the Examinin. Surgeon stated:
Il find no disease of kidneys, at least
examination of urine is negative; but no
doubt trouble of hack is rheumatic.
1.-The last report. in 1899, showed so per
cent by volume of albumin in the urine,
and the board stated that in their opinion
the soldier had a chronic form of inter
stitial nephritis and albuminuria as a re-
suit; the urine was acid and its specific
gravity 101S.
In this case the character
istic symptoms of uraemia Were not de-
scribed at any time. the specific gravity
was nearly normal, the amount of albumin
was 80 per cent by volume, and no hyper
trophy of the heart was shown. From
these data it would appear that the dag
nosis of chronic interstitial nephritis was
incorrect.
''It appears that the soldier incurred the
disease of the left leg while in service as
sequel of typhoid fever. The affection
first examination, as 'varicose condition of
the veins of the leg and foot with large
ecZematOus patch with purple base and
surrounding oedema,' which the EXamin-
ing Surgeon stated was the alleged OF
supposed rheumatism The reports in
1890 and 1891 showed numerous scars
from rupture of veins and liberation and
marked enlargement of the left leg. In
1896 the Examining Surgeon stated that
the left leg might as well have been am
putated SO far as its usefulness was con-
cerned; that from the foot 10 the knee it
was enlarged, indurated, and discolored,
with an eczematous eruption over pOr-
ton of it, having the appearance of ele-
phantiasis. The condition in 1899, two
weeks before death, is set forth above.
although open liberation of the leg
.1..I 80 h. ,nl
reports, as stated by the Medical Referee,
the later reports show that scars existed
from such liberation, and the evidence es-
tablishes the fact that liberation occurred
at different times. All of the reports
showed eczematous eEuptions, generally
severe.
From the statement of the widow it
appears that the trouble was aggravated
or that local infection occurred on the
left leg about two weeks before the sol
dier went to .Wausau to be examined. She
describes painful streaks on each side of
the ankle, which kept working upward.
The report of the Board showed eczema
encircling the left leg from the knee to the
instep, the entire surface being 'ecchymOs-
ed,' and comparative measurements show
ed this leg two and a half inches larger
at the calf and four and a half inches
larger at the ankle than its mate. About
two days after this examination the leg
again became painful and swelled rapid
ly, and it was about this time the doctor
was called; but it was not until three
or four days after this that the soldier
took to his bed, and he died about q week
thereafter.
'The symptoms manifested during the
fatal illness point to the disease of the
leg and the gangrene which ensued therein
as the actual causes leading to the death
Of the soldier, although disease of kidneys
may have been complication, as stated
above.
'The mere fact that the soldiers urine
was found to contain 80 per cent of albu-
min by volume two weeks before his death
is not sufficient to warrant the conclusion
that disease Of kidneys was the cause
thereof, yet this appears to be the basis
Of the action. The presumption of the
Medical Referee that disease Of the kid
neys was the cause of death is not sus-
tanned by the testimony. The same large
amount of albumin was found in 1898
in the case of another pensioner, who filed
an appeal year thereafter, and he was
apparently still alive when his appeal was
recently considered by the Department.
Cease Of James l.. Hammack, Docket No.
59Ss7)
Large amounts Of albumin are found
in some forms Of kidney disease, but this
is not the element of special danger. The
danger in all affections Of the kidneys is
from failure to eliminate some Of the Or
dinary constituents of the urine, which
gives rise to uraemia. AS stated above,
the characteristic symptoms of uraemia
were not described in this case at any
time. The marked prostration, delirium,
stupor, etc, during the fatal illness appear
to have been symptomatic of the gangrene
rather than indicative of possible uraemia.
Moreover, it is not impossible that the
affection of the kidneys may be traced to
the disease of the leg itself. But this
feature of the case will not be discussed,
as it appears unnecessary.
"From this careful review of the evi-
dence it is clear that the pensioned disa-
bility cannot be ignored as predisposing
cause of the fatal gangrene of the left leg,
and no other considerable cause has been
shown. The leg had been in a diseased
condition for many years, and, whatever
may have been the exciting cause, wheth-
er it was merely the exertion from run
ming over town the day he was examined
or something apparently less trivial, the
fact remains that this chronically y-dseas.
ed leg became gangrenous and caused the
soldiers death. In the opinion of the De
partment the fatal disease, gangrene of
the left leg, should be accepted as result
ing from the pensioned disability, compli-
Gated by disease of kidneys.
"The action rejecting the claim is there.
fore reversed, and you are directed to re-
adjudicate the claim in accordance with
| this view of the case"