Employee's Claim for Compensation. 10 Was it at the plant or away from it? At plant. State occupation when injured: Screwing caps on back sheet. How long have you worked at this occupation? 18 months. How long have you worked for present employer ? 9 Yes. 11 Piece or time worker? Piece work. Wages per full day? $1.00 per hour. How did accident happen? Placing cap on back sheet; Boy came from other side of sheet with acetylene torch leaving light through door hole striking eyes. State fully nature of injury: Losing his eye sight. (Caused by injury.) Name of employer: American Locomotive Co., Jay Nature of business. Locomotive builder. So, when? Latter part of June 1919 and had to stop. Have you received any wages (this does not mean compensation) since the date of your accident? Yes. If you have been paid your wages, to what date? October, 1919. Will you be able to take up regular employment when you return to work? No. If not, why not? Eye sight failing on account of injury. 12 Attending Physician's Report. 13 Name of attending phycician: Dr. J. E. Reid and Dr. Lord. If taken to hospital, give name and address of hospital and date: No. Signed, this 12th, day of May, 1920, at Schenectady, N. Y. JACOB OLAS, 815 Eastern Avenue. State of New York, SS. : On this 12th day of May, 1920, personally appeared before the undersigned, a Commissioner of Deeds in and for the said County and State, the above named Jacob Olas to me well known, and to whom I have read the foregoing questions and answers, and all the 14 matter above stated, and who, after being fully advised in the premises, subscribed his name thereto in my presence, and made oath that the foregoing statements, and each and all of them, are full and true, and are made without reservation or concealment. DENNIS MAHAR. Post-office address 97 Mason St., Schenectady, N. Y. ATTENDING PHYSICIAN'S REPORT. 1. Name of injured person: Jacob Olas. Address: 15 815 Eastern Ave. 2. Name of employer: American Locomotive Co. Address: Schenectady, N. Y. Attending Physician's Report. 3. Date of accident. June 4, 1919, at 2:30 p. m. Was first treatment rendered by you? No. When? 16 At once. 4. If not, by whom? American Locomotive Hospital. Address: Schenectady. 5. Who engaged your services ? The patient. 7. Give an accurate description of the nature and extent of the injury: Burn of both eyes, said to have been caused by electric flash and gas in electric welding. 8. Will the injury result in (a) a permanent defect? Do not know. 17 11. On what date do you think the injured can resume work? He returned to work June 16 or 17, 1919. 12. State, in patient's own words, how accident occurred: Was working near this welding when he received the flash. J. E. REED, 702 Union Street, Schenectady, N. Y. NOTICE OF AWARD. Case No. 14985-A. April 19, 1921. 19 To Amer. Locomotive Co., Schenectady, N. Y., em ployer; and Jacob Olas, 815 Eastern Ave., carrier. Future payments, $30.00 every two weeks. Closed. Failure to give notice of injury excused on statutory grounds. You are hereby notified that at a meeting of the State 20 Industrial Commission held April 4, 1921, a decision and award of compensation was made in the above matter, and the case was closed. STATE INDUSTRIAL COMMISSION, Bureau of Workmen's Compensation. Secretary. Chief of Claims. REPORT OF DR. O'BRIEN. June 4, 1920. 22 Mr. E. L. King, American Locomotive Co., Schenec tady, N. Y.: I have examined the eyes of Jacob Olas, who claims to have had them burned by a welding torch, June 4, 1919, and find the following: The cornea and media in both eyes are clear, pupil active, the retinal nerve vessels and fundi are negative. The extra ocular muscles are normal. He has some conjunctivities of his lids. He refuses to see a single letter for me on the Snellan chart with either eye even, at a distance of a foot. He, however, easily weaved his way between several chairs which I purposely placed in his way. He also promptly told me what my pencil was, but could not distinguish between a cent, dime, quarter and fifty-cent piece, and did not recognize a one and two dollar bill. I retiniscoped his eyes and found a small error of refraction in each eye. R. plus 25 S. plus. 500 a 90.—L. plus. 50. c.a.90. As far as vision is concerned this is negligible. I believe this man is faking. There may be some loss of sensibility of the retinal fibres that would be due to a constitutional taint, but there is no pathology to account for his almost complete loss of vision. I am, 23 Yours truly, (Signed.) JOHN J. O'BRIEN, M. D. |