Please use charts on back for illustration, especially for charting fields 1. Name of injured person Christopher Hanify 2. Present address (Street and number) 230 West 99th Street, New York City (City or town). 3. Name of employer Edgar Cadmus, Receiver, Slawson & Hobbs Agts. 4. Office address 162 West 72nd Street, city 5. Date of accident October 19, 1935 at 10:30 P. M. 6. Who rendered first treatment? Dr. M. L. Janes Address 118 W. 74th St. 7. What was nature of the injury? perforating wound of the globe 8. Was there any previous disease, injury or defect of part now affected? no history If so, what? 80 81 82 83 84 Eye Surgeon's Report, February 28, 1936 9. Did previous injury, disease or defect cause any permanent impairment of vision? If so, to what extent? no 10. What is the acuity of central vision uncorrected? O. D. light perception O. S. 20-15 O. D. O. S. (Express in usual way) 11. Is the loss, if any, after the correction of vision, the result of present accident or of conditions resulting therefrom? yes 12. Will this percentage increase or decrease with time? can be improved by operation 13. State the condition of the binocular vision and whether depth perception is present, absent or defective complete loss 14. Is there any loss of binocular vision? complete loss If so, what? Is such loss due to the present accident or to conditions resulting therefrom? yes 15. Is there any loss of ocular movement or any defect in the ocular muscles? no If so, what? Is the defect due to the present accident or to conditions resulting therefrom? 16. Is there any other disturbance of the normal function? no If so, in what way does it affect the injury? Is the defect due to the present accident or to conditions resulting therefrom? 17. Is the present condition likely to cause any sympathetic condition in the uninjured eye? undetermined Eye Surgeon's Report, February 28, 1936 85 18. On what date do you think the injured person will be able to resume his usual work? working 19. On what date able to do any work and nature of work? Remarks (Add here any other information you may think material as to eye condition) see remarks on reverse side. Remarks: In view of the fact that Dr. Jane's report states that patient was discharged on Nov. 8, 1935 as being entirely recovered from the injury, it is my opinion that there was no cataract prior to the injury on the date specified by Dr. Janes. Therefore, this perforating wound of the lens was producing this cataract which has developed up to the present time to the state of maturity which I now find, and which is ready for removal, preferably by the Homer-Smith Operation. I am a graduate of Tufts College, year, 1917, and have practiced as an eye specialist for 13 years. Dated Feb. 28th, 1936 WALTER R. LEOWE, M. D., F. A. C. S. State of New York, 86 87 being duly sworn, deposes and says: That he is the physician who subscribed to the above (or attached) report; that he has read the same and knows the contents thereof; that the same is true to the knowledge of the deponent, except as to the 88 Eye Surgeon's Report, February 28, 1936 matters therein stated to be alleged on informaion and blief, and as to those matters he believes it to be true. 89 Subscribed and sworn to before me this Jacob Karpe, Notary Public. N. Y. Co. Clks. No. 252, Reg. No. 6-K450. (Seal) Eye Surgeon's Report, February 28, 1936. WALTER R. LOEWE, M. D., F. A. C. S. 1114 Madison Avenue (At East 83rd Street) New York, N. Y. February 28th, 1936. Insurance Carrier No. 98717765 Patient: Christopher Hanify 230 West 99th Street New York City Employer: Edgar Cadmus, Receiver Insurance 162 West 72nd Street, N. Y. Carrier: Royal Indemnity Company 150 William Street, N. Y. Injured: October 19, 1935 88a 89a At the request of Mr. Hanify I am sending you a report of my findings in his eye condition. COMPLAINT: Patient states that since October 19, 1935, he cannot see as well as he did prior to accident on right eye which was injured at that time. |