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 threefold: 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 attacks.
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.
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.
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.
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 cerebral embolism.
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., 1927, 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 Debuque.
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 No. 10,541.
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.