in the engine room, plaintiff suffered additional damage to his
heart, which ultimately brought about a cerebrovascular accident
four months later. Thus, in order to show a causal connection
between the alleged negligence and his present condition, it is
essential that plaintiff establish a physiological relationship
between the two heart attacks which occurred on board the vessel
and the subsequent stroke. He has failed to meet the burden of
proof in this respect, thereby rendering unnecessary a
determination of whether the conduct complained of amounted to
negligence under the circumstances.
The major types of cerebrovascular accidents such as plaintiff
suffered are three-fold: cerebral hemorrhage, cerebral thrombosis
and cerebral embolism. Cerebral hemorrhage is the actual rupture
of one of the arteries in the brain, with a pouring out of blood
into the hemisphere of the brain, accompanied by severe headache
and paralysis, and often resulting in death. Cerebral thrombosis
is the blocking of a cerebral artery by a thrombus, or blood
clot, which develops in situ — in the particular artery affected.
One of the known causes of cerebral thrombosis is arterial
disease (arteriosclerosis), in which the lining of a cerebral
artery becomes roughened, and blood fribrin platelets collect on
the roughened part until they fill up the artery and gradually
shut off the blood supply to part of the brain. The third type,
cerebral embolism, consists of a more sudden blocking of a
cerebral artery by a clot which originates elsewhere in the body
and is carried to the brain through the circulatory system.
Plaintiff attempted to prove that he suffered a cerebral embolism
as a direct result of the heart attacks of August 15 and 20,
1948. Defendant contended that the cerebrovascular accident was
entirely unrelated to these heart attacks; that plaintiff had
long been suffering from a generalized condition of
arteriosclerosis throughout his body; and that this disease
resulted in a cerebral thrombosis which first manifested itself
on December 18, 1948, completely independent of the two heart
Plaintiff's expert witness, Dr. Gelfand stated that in his
opinion clots known as mural thrombi developed on the infarct
area, or damaged tissue, of plaintiff's heart as a result of the
two attacks on board the vessel; that one or more of these mural
thrombi broke away from the inner wall of the heart, travelled
through the blood stream and finally settled in a cerebral
artery; and that the likelihood of this happening would have been
greatly reduced had plaintiff been relieved of all duties and
given complete bed rest after the first attack.*fn1 Defendant's
expert witness, Dr. Vander Veer, stated that upon examination of
the plaintiff in the Naval Hospital in September, 1949, he found
"evidence of arterial changes of a rather marked degree", as well
as a history of diabetes and high blood pressure, which are
recognized causes of arterial disease. Dr. Vander Veer was firmly
of the opinion that plaintiff's condition was the result of a
cerebral thrombosis. In negativing the possibility of cerebral
embolism he attached great significance to the lapse of four
months between the two heart attacks in August and the onset of
the paralysis in December, stating that the usual period of time
during which emboli break loose from the heart wall after a
myocardial infarct is from two to four weeks after the date of
the attack, and that he had never seen it occur more than six
weeks afterward.*fn2 His diagnosis was also based upon the mild
onset of the paralysis and marked increase in symptoms between
December 18 and 27, which he considered indicative of a
"spreading clot" rather than the "sudden jolt" of an
embolism.*fn3 I have
credited the diagnosis of Dr. Vander Veer over that of Dr.
Gelfand, and, accordingly, find that plaintiff's present
condition is the result of cerebral thrombosis rather than
It is fundamental that in a Jones Act action the plaintiff must
prove his case "by a preponderance of the evidence". Cruse v.
Sabine Transp. Co., 5 Cir., 1937, 88 F.2d 298, 300, certiorari
denied 1937, 302 U.S. 701, 58 S.Ct. 20, 82 L.Ed. 541. See also
Sandoval v. Fruit Express Co., 1944 A.M.C. 580 (D.C.D.C.Z. 1944).
Plaintiff has not met this burden.
Further, the diagnosis of cerebral thrombosis was amply
supported by other evidence — the predisposing factors of
generalized arteriosclerosis, high blood pressure and mild
diabetes, as well as the Naval Hospital records showing the
increased symptoms characteristic of cerebral thrombosis. The
"preponderance of evidence" is by far in favor of defendant.
Plaintiff has failed to prove that the negligence alleged was the
proximate cause of his present condition. Accordingly, he cannot
recover damages in his civil action.
I state the following
Conclusions of Law
1. Plaintiff has failed to establish a causal connection
between the cerebrovascular accident which first manifested
itself in December, 1948, and the heart attacks suffered on board
the S.S. Julian Dubuque.
2. Plaintiff has failed to establish that the alleged
negligence of defendant's servants was the proximate cause of his
present condition of hemiplegia.
3. Plaintiff is not entitled to recover damages in Civil Action
4. Plaintiff is entitled to recover maintenance in the amount
of $24 and wages in the amount of $900.98 in Admiralty Action No.
31 of 1950.
Orders may be submitted in accordance herewith.