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It is impossible to say what connection existed between Mr. Mills' injury on September 18, 1937, and his death on August 18, 1939. At the time of his death, he had not recovered from the original injury, but the immediate causes of his death appear to have been unrelated to that injury, except that, perhaps, his weakened condition resulting from his long suffering following the injury left him in not the best condition to combat those developments which caused his death. Whether he would have recovered had it not been for the injury is problematical.

Of course the late Harry Mills suffered permanent injury in the loss of his right leg as a result of his accident. Probably, except for that accident, he would have returned to some gainful employment immediately after the expiration of his sentence on October 20, 1938. Accordingly, it would appear that some compensation is in order regardless of whether his death is considered in determining the amount to be paid.

As for Mrs. Mills' claim for compensation, it is noted that she and her husband were separated some time before his conviction and sentence. She is a high-wire performer in carnivals and circusés, and is self-supporting and apparently has never been dependent upon her husband for her livelihood. Mr. Mills, before his sentence, sold novelties and articles at fairs, circuses, and on street corners, but the amount of his earnings is not known. Beyond these facts, the extent of Mrs. Mills' financial loss is not indicated by the files of this Agency.

In this situation, it is suggested that your committee may desire to provide for a somewhat smaller cash settlement for Mrs. Mills than the proposed $5,000, or it may be wise, in view of the great difficulties presented in determining the extent of damage in this case, to authorize and direct the United States Employees' Compensation Commission to consider and settle the claim as if Mr. Mills had been an employee of the Government.

For the information of your committee, there are enclosed the following:

1. Photostat of letter dated June 27, 1941, to the Surgeon General from the medical officer in charge, United States Public Health Service Hospital, Lexington, Ky.

2. Copy of letter dated March 6, 1940, to Mrs. Julia Peterson Mills from the medical officer in charge, United States Public Health Service Hospital, Lexington, Ky.

3. Copy of letter dated May 21, 1941, to the United States Employees' Compensation Commission from the medical officer in charge, United States Public Health Service Hospital, Lexington, Ky.

4. Photostat of letter dated July 16, 1941, to the Surgeon General from the medical officer in charge, United States Public Health Service Hospital, Lexington, Ky.

Sincerely yours,

PAUL V. MCNUTT, Administrator.

MOUNT CLEMENS, MICH., August 28, 1941. HONORABLE SIR: Your letter just received. It had been delayed and had to send a stamp before I could get it. I am at this address temporarily, then back to Detroit, but will let you know.

My late husband, Harry Mills, and I were never really separated until I had my bad accident. That happened in Ecorse the 5th of July, 1935. He always helped me for I never worked very steady, and when I did, he was working on the same show or fair. In 1933 and 1934 he worked at the Ford plant after taking a cure and we were getting along fine until he was laid off and went on the road again. That was the summer of 1934. The winter of the-or I should say part of the winter I stayed at the Morris Hotel for Harry was working with another fellow in and out of Detroit; he came to see me every day or so and gave me money to live on. When summer came of 1935, I moved to a tourist camp on Fort and Schaefer so that I might put up my rigging and practice. Harry came out there two or three times and gave me money to live on. My first date was the Fourth of July celebration at Ecorse. I fell and was taken to the Wyandotte Hospital where I spent the rest of the summer. Harry came to see me and gave me money to pay the hospital and friends helped me pay for incidentals. I stayed with some friends in Melvindale and Harry came there and said he had better stay in Detroit so he could find something to do so he could help me for I was still on

crutches.

H. Repts., 71-1, vol. 1-17

The house was sold where I was living and the people moved into their trailer. I then moved to a rooming house with some entertainers and tried to rent my rigging then to manage the act which put me way in debt. I had not heard from Harry in some time and was worried about him, for I was sure he was in more trouble. I received a letter from him saying he was in Lexington and when he was well he would go back to work and I wouldn't have to worry. I didn't write very often because I didn't want him to know that I had to go back to the hospital and have bone taken out of my ankle, which was coming through. The actor I was living with was sent out of town and I could not work, as I mentioned before. as I was on crutches and had to ask for help and received welfare relief that I had for 5 months when a close friend died and left a daughter alone. He left enough insurance for her to buy a trailer and used car. Not knowing anything about keeping house or cooking, she asked me to live with her. Of course, living with her I notified the welfare, and am still living with her, but her money can't last with everything going out and nothing coming in. I sold my rigging and paid her part of the money she had spent on me for clothes and expenses wherever we went; and to Lexington to see Harry on two occasions. I've been trying to sew a little, but I couldn't even do enough to pay trailer rent, which is very small.

These are girls of her own age that are working and could share expenses with her. If I had a small income I'd feel a little more independent; as it is I am pretty much of a burden.

I had written everything I can think of other than I am 45 years old and cannot walk over three or four blocks at a time as my ankle swells terribly and hurts so badly that I just can't walk. My heart has been bad for some time and worry doesn't do it any good.

Thank you more than I can write for your being so kind to me. I only wish there was a way I could show you my appreciation.

Yours truly,

JULIA PETERSON MILLS.

FEDERAL SECURITY AGENCY,

UNITED STATES PUBLIC HEALTH SERVICE,
Lexington, Ky., June 27, 1941.

Re Harry Mills, No. 3860-Lex. (deceased).

The SURGEON GENERAL,

United States Public Health Service,

Washington, D. C.

SIR: This is to acknowledge receipt of Service letter of June 17, 1941, JEH/FIS, enclosing a copy of H. R. 5048, Seventy-seventh Congress, first session, for the relief of Julia Peterson Mills, widow of the above named.

The facts surrounding the death of the patient are as follows: On September 18, 1937, while in good physical condition, the patient fell a distance of about 6 feet from a tree on the reservation. He was occupied at the time in sawing some dead limbs from the tree. At the time of the fall he sustained a compound comminuted fracture of the right tibia and fibula just above the ankle joint with gross contamination of the exposed bone.

In spite of preventive treatment, osteomyelitis developed and union of the fracture failed to occur. The patient was in bed for a considerable period of time, following which he was up in a wheel chair. The oesteomyelitis became chronic and stubbornly resisted treatment. General debility and systemic weakness resulted from this focus of infection. His condition remained unchanged and finally, after consultation with an outside orthopedic specialist, it was considered advisable to amputate the leg and on July 7, 1939, the right leg was amputated below the knee, following which the patient appeared to convalesce as satisfactorily as could be expected considering his prolonged illness.

On August 8, 1939, while still convalescent, the patient complained of some pain in the right lower quadrant of his abdomen. The symptoms were suggestive of acute appendicitis but the patient had a scar in this region which he stated was the result of an operation for the removal of his appendix a number of years earlier. There was a small mass palpable in the scar and it was the surgeon's opinion that there was a piece of omentum incarcerated in the old scar. On August 9, 1939, the patient appeared to be worse and complained of pain originating in the left iliac spine and radiating into the penis. In view of the history of appendectomy it was felt that the patient was in all probability suffering from an attack of renal colic.

Early in the morning of August 10, 1939, the pain became generalized and the abdomen rigid. An exploratory laparotomy was performed; a gangrenous appendix filled with fecoliths was found. Due to extensive adhesions it was impossible to remove the appendix. Drains were inserted and the wound closed. The patient was extremely ill but by August 13, 1939, he seemed to be somewhat better. On August 14, 1939, the patient did not seem so well and on August 16, 1939, the diagnosis of pneumonia was made. His clinical course was progressively down hill and he expired at 5:25 p. m., August 18, 1939.

Autopsy was performed at 11 a. m., August 19, 1939; the gross anatomical diagnoses were: (1) Peritonitis with hemorrhage; (2) unhealed, operative incision, abdominal, right lower quadrant; (3) pneumonia, upper portion, lower lobe, left lung; (4) congestion of spleen and liver; (5) unhealed amputation, right lower leg; (6) osteomyelitis, chronic, right tibial stump.

Microscopic anatomical diagnoses revealed arteriosclerosis, aortic and coronary, in addition to the above-named conditions found grossly.

As stated on the death certificate the immediate causes of death were considered to be appendicitis and peritonitis. The contributory cause of death was considered to be pneumonia.

All of the above is covered in station letter of September 5, 1939, to the Service, reporting the death of the patient.

The report of industrial injury filed at the time of the accident of the patient and signed by Mr. M. A. Jackson, carpenter foreman of this station, stated the cause of the accident as follows: "Saturday morning, September 18, 1937, about 10:25 a. m., I had gotten the top out of an ash tree which in falling stood on end with the big end up. I told the men to throw a tag line around the end from the ground so we could put a large line around the limb and pull it over. Mills climbed the limb, his weight overbalanced it causing it to start falling, and when about 6 feet from the ground Mills jumped, breaking his leg." The patient upon interview stated he climbed limb that had fouled and his weight overbalanced limb, causing it to start falling and when the limb was about 6 feet from the ground he jumped, breaking his leg. Patient claimed that "it was just a freak accident, and that if he jumped the same distance again, a similar accident would not happen."

There is enclosed herewith a copy of station letter dated March 6, 1940, to Mrs. Julia Peterson Mills, and a copy of station letter of May 21, 1941, to the Acting Chief Claim Examiner, United States Employees' Compensation Commission. The last paragraph of the letter to Mrs. Mills contains our considered opinion as to the possible relationship between the accident and his subsequent death.

Respectfully,

Mrs. JULIA PETERSON MILLS,

Detroit, Mich.

J. D. REICHARD, Medical Officer in Charge.

MARCH 6, 1940.

DEAR MR. MILLS: This will acknowledge receipt of your letter of March 1, 1940, addressed to Dr. Cronin of our staff, in which you ask for information concerning your late husband, Harry Mills, who was a patient in this hospital. On September 18, 1937, your husband fell a distance of about 6 feet. He was occupied at the time in sawing some dead limbs from some trees on the reservation. At the time of the fall he sustained a fracture of the right leg near the ankle which was of sufficient severity that the broken bone was forced through the skin so that it was exposed and it became contaminated by the earth onto which he fell. The technical term for this injury is a compound comminuted fracture. Fractures of this type are always serious since there is a very great possibility of infection of the bone which retards healing and sometimes has farreaching consequences.

Every effort was made to prevent infection but even so this developed. This infection is known as osteomyelitis. As a result of this condition the broken bone failed to heal and it was necessary to continue him under treatment for a prolonged period of time. He was in bed for a considerable period of time, following which he was up in a wheel chair. The infection of the bone became chronic and stubbornly resisted treatment. His condition finally reached a point where, although he could limp about with the aid of a cane, he was incapacitated for almost any type of work where he could not sit down.

Even though he could walk about on his leg his health was being undermined by the bone infection. Because of his condition he requested to be continued under treatment here beyond his maximum expiration date, which was October 20, 1938. This request was granted and he was carried here as an ex-prisonerpatient from October 20, 1938, until his death. His condition remained unchanged and finally after consultation with outside specialists it was considered advisable to amputate the leg. On July 7, 1939, the right leg was amputated below the knee and the patient appeared to be convalescing as satisfactorily as could be expected considering his prolonged illness.

On August 8, 1939, he complained of some pain in the right lower portion of his abdomen. Of course, pain in this region always makes one suspicious of appendicitis but upon examination he was found to have a scar in this region which he stated was the site of an operation for the removal of his appendix which had occurred a number of years earlier. Since we were told that his appendix had been removed, the surgeon continued the study of the case in an effort to make a diagnosis. There was a small mass which could be felt in the scar and the surgeons felt that there might be a small piece of tissue, which normally should be contained in the abdominal cavity, incarcerated in the scar tissue. On August 9, 1939 he appeared to be worse and complained of pain which was quite typical of kidney colic. It was felt at that time that since there was a history of having had his appendix removed and having had a drainage tube inserted following the operation for some time that the kidney diagnosis was quite logical. Early in the morning of August 10 he became worse, and it was thought advisable to perform an exploratory abdominal operation since now the symptoms indicated a serious condition inside the abdomen. A gangrenous appendix was found and drains were inserted into the wound since it was impossible due to the condition of the appendix, to try to remove it. By August 13, 1939, he seemed somewhat better but by August 16 he developed pneumonia and from then on his course continued downhill, until he expired at 5:25 p. m., August 18, 1939.

Following the amputation of your husband's leg he improved quite satisfactorily as far as his general physical condition was concerned but, of course, his long illness must have lowered his resistance somewhat. It would be difficult to state definitely that there was any direct relationship between the bone infection and his death, but it is felt reasonable to assume that had he not gone through his long illness he might have been more able to withstand his attack of appendicitis complicated by pneumonia. If we can give you any further information, please do not hesitate to write us.

Very truly yours,

J. D. REICHARD, Medical Officer in Charge.

FEDERAL SECURITY AGENCY,

UNITED STATES PUBLIC HEALTH SERVICE,
Lexington, Ky., May 21, 1941.

Re Harry Mills, our former No. 3860-Lex., your file No. LF-59355.
Miss VELVA M. FERRELL,
Acting Chief Claim Examiner,

United States Employees' Compensation Commission,

Washington, D. C.

DEAR MISS FERRELL: This is to acknowledge receipt of your letter of May 17, 1941, and in reply thereto you are advised that the above-named was a former prisoner-patient of this hospital serving a sentence imposed in the United States courts for violation of the Harrison narcotic law.

The injury referred to occurred when the patient fell out of a tree at this hospital. The case was not reported to the Commission due to the fact that the patient was not an employee of the United States Government. However, the incident was reported to the Bureau of Prisons in accordance with regulations. If there is any further information that the Service can furnish you, please do not hesitate to write.

Respectfully,

J. D. REICHARD, Medical Officer in Charge.

FEDERAL SECURITY AGENCY,
UNITED STATES PUBLIC HEALTH SERVICE,
Lexington, Ky., July 16, 1941.

Re Harry Mills, our former 3860-Lex.
The SURGEON GENERAL,

United States Public Health Service,

Washington, D. C.

SIR: Reference is made to Service letter of July 11, 1941, with reference to industrial efficiency of the above-named deceased patient, and in reply thereto you are advised that the record of this hospital reflects the fact that the patient had been a general salesman, however, the records on file indicate that the wife of the. patient had left her husband because of his addiction to alcohol. Mrs. Mills is a high-wire performer in carnivals and circuses and made her own living. The deceased, insofar as can be determined by this hospital, sold novelties and articles at fairs, circuses, and on street corners and was referred to as a "pitch" man. This station is unable to state definitely as to just what the earnings of the deceased might have been had he lived. He had no plans made other than to return to Detroit at the expiration of his sentence at this hospital and reengage in the business of "general salesman." However, after his accident occurred, and he was forced to remain in this hospital for further treatment because of the injury to his leg, he did not indicate to the Social Service Department as to just what his plans would be.

Respectfully,

Hon. GEORGE D. O'BRIEN,

W. K. M.,

Medical Officer in Charge.

DETROIT, MICH., August 27, 1941.

House of Representatives, Washington, D. C.

DEAR SIR: Mrs. Julia Peterson Mills has been a patient of mine for the past 10 years. Her general physical condition with particular reference to her heart and left ankle makes it absolutely impossible for her to work.

O

R. R. KALLMAN, M. D..

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