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"History: Child was struck by a car and brought into hospital by driver who stated that child was unconscious when found. A short time later became excitable but never rational History of fracture of right arm 3 years of age.

"Abstract of physical examination: Overdeveloped thrashing wildly about. When questioned responds only with grunt. Seems to have difficulty with respiration, stopping short before the end of inspiration. No cyanosis evident. "Head: Multiple abrasions. "Right ear canal filled with blood which seems coming from inner ear. “Pupils equal and regular, react. Grounds not visualize. "Pain right upper thorax lateral, no deformity felt. "Limitation of inspiratory excursion and bronchial rale. "No parenchymal rales. No change in breath sounds On April 6, 1944, Dr. Russell K, Tether, of Englewood, N. J., submitted the following statement:

“Louis Ciniglio was treated for compound comminuted fracture of the lower third of right humerus, fracture of base of skull, laceration of brain, fracture of right scapula, contusions and abrasions of frontal region of scalp and left elbow region.

“At the present time this boy has a 100 percent function of the fractured upper extremity. He complains of occasional headache which is his only symptoms resulting from the skull injury. The prognosis is good and I think he will have no permanent disability."

The following report of a physical examination performed on Louis Ciniglio, Jr., by Army medical officers on or about April 1, 1944, has been submitted by Capt. J. W. Cowden, Medical Administrative Corps, General Dispensary, United States Army, 39 Whitehall Street, New York, N. Y.:

“MEDICAL EXAMINATION

“History of injury by Army car on June 19, 1943. Details not obtainable from subject because of mental status.

"Examination reveals well-developed, well-nourished, 12-year-old male child. Subject is in no apparent discomfort, is cooperative and friendly. He has no complaints at this time.

" Examination of heart and lungs is essentially negative. Abdomen is also found to be negative on examination.

"ORTHOPEDIC EXAMINATION “1. No clinical evidence of fractured ribs on the right side at the present time. “2. Right humerus: Firm, nonadherent scar 4 to 5 inches long extending along the outer surface of the right arm, from the middle of the arm to the elbow joint. Scar is not tender, but patient states that the scar'feels funny' on pressure. There is a very slight impairment of complete extension of the right elbow, less than 5 percent limitation of motion. "3. No clinical evidence of fracture of the right scapula at the present time. There is no impairment of function of the right shoulder joint.

“NEUROPSYCHIATRIC EXAMINATION "History of head injury in June 1943. Report of the Englewood Hospital, Englewood, N. J., reveals that he was in the hospital from June 19, 1943, to August 18, 1943. He was admitted with a diagnosis of fracture of the base of the skull; laceration of his brain; contusion and abrasion of the frontal area of the head and of left elbow region; and fracture of right scapula. According to the hospital report he was unconscious for a short period of time and then became exeitable.

“Electroencephalogram performed at the Fort Jay station hospital on April 2, 1944, revealed a pattern suggestive of a fairly diffuse cerebral disturbance.

"Psychometric examination performed on April 1, 1944, by the Military Personnel Division, revealed a mental age of 8 years and 6 months on the StanfordBinet Intelligence Scale, Form L, and intelligence quotient of 68.

"According to his school records, he showed an I. Q. of 62 in September 1936, and some adjustmental difficulties in his classwork. This boy shows a borderline intelligence--the same as he was before the accident, as shown by his school records.

“Neurological examination is essentially negative except for the slight speech impediment which was also present before the accident. At the present time he is a rather dull-appearing boy who cooperates well during the examination. His pupils are equal and react well to light and accommodation. There are no cranial nerve palsies. The deep reflexes are present and equal. There are no pathological reflexes. There are no sensory changes and no disturbances of station or gait. The only objective finding at the present time that may be a sequel of the head trauma is the diffuse cerebral change noted on the electroencephalogram.

"One can say that this child's post-traumatic sequelae are minimal at the present time. The future course, however, is uncertain.

"REPORT OF X-RAY STUDIES “X-ray of skull: Skull within normal limits and shows no evidence of bone injury or disease.

"X-ray of right scapula and right shoulder: The right scapula shows some irregularity, and a bony defect, inferiorly toward the angle, suggestive of an old, well-healed fracture. The shoulder joint itself and upper end of humerus appear within the limits of normal.

“X-ray of right humerus: The epiphyseal line at the distal end of the right humerus of the external condyle appears to be blurred when compared to the left, but the elbow joint does not appear to be abnormal. The shaft of the humerus, in its distal third, shows a Lane plate placed in the long direction of the bone, with four screws, about 2 inches above the joint. The bone in this area shows some broadening and minimal sclerosis, and shows evidence of a wellhealed fracture with almost perfect anatomical restitution. Impression: Wellhealed fracture of shaft of humerụs above the elbow joint; latter uninvolved.

“X-ray of right ribs: The ninth and tenth ribs posteriorly, on the right, just distal to the neck, show irregular broadening suggestive of old, well-healed fractures. The eighth rib shows equivocal broadening, which may conceivably be due to a similar old healed fracture.

**SUMMARY "Louis Ciniglio was given medical, orthopedic, neuropsychiatric, and X-ray examinations. In addition to the routine neuropsychiatric examination an electroencephalogram and psychometric examinations were performed. His previous hospital records and school records were also obtained and studied.

“These examinations and studies reveal no residual impairment of function in the right upper extremity with the exception of a 5 percent limitation in extension of the right elbow. This minimal involvement in a patient of his age is of no estimable significance. The fractured ribs sustained at the time of the accident are now healed and function is not impaired. There are no bony abnormalities of skull demonstrable at this examination.

“His present mental status is improved as compared with school records of 1941 and therefore no blame can be placed on the accident in this respect.

"The diffuse cerebral disturbance as demonstrated by the electroencephalogram is probably due to the trauma sustained at the time of his accident. However, it is impossible at this time to estimate the degree of mental disability from these findings.”

The school record of Louis Ciniglio, Jr., reads in pertinent part as follows:
“Entered Palisades Park schools, kindergarten, September 1936.
“I. Q.: Approximately 62.

HEALTH RECORD

“Louis' health, according to his health card, has been good since he entered school. He is rather small and underdeveloped for his age.

"ACADEMIC PROGRESS “June 1937: Promoted to grade 1 after 177 days in kindergarten, “June 1938: Repeated grade 1. “June 1939: Advanced to grade 2 becaues of age. “June 1940: Advanced to grade 3 because of age. “June 1941: Advanced to grade 4 because of age.

"Transferred to Ridgefield Park, September 12, 1941. Reentered, November 2, 1942. Placed in grade 5 temporarily, then transferred to opportunity class.

"1942-44: Opportunity class (personal observations of teacher noted below).

“1942–43: 'Louis entered opportunity class after having spent a year in Ridgefield Park. He is slowly overcoming his speech defects and is acquiring the habit of working along with the group on his own level. He started out in the first of the year as a nonreader due to his low mental age. Slowly. progress has been made in reading readiness. Louis is very loud at times, but seems to make every effort to control this emotion. He is accepted by the fifth-grade boys in their games on the playground.'

“1943-44: "During this school year, Louis has shown a great deal of interest in his work and the results have furnished him with a certain amount of satisfaction and an incentive to work very hard. Louis has started to read and can recognize and spell many of the words in his reading book. He has learned practically all of the arithmetic combinations. He is very persistent and is now able to concentrate on what he is doing.'

Statements in the files of the War Department disclose that for the treatment of the injuries sustained by Louis Ciniglio, Jr., in this accident the following bills have been incurred: Englewood Hospital Association...

$434. 10 Surgical A staff connected with Englewood Hospital.

606, 00

Total..

1, 040. 10 The following information is of record in the War Department concerning the family of Louis Ciniglio, Jr.:

Father: Louis Ciniglio, age 52, is employed in a bleachery, earning approximately $35 per week.

Mother: Carmella Ciniglio, age 45, housewife.
Sister: Rose Ciniglio, age 19, earns approximately $42 per week.
Sister: Mary Ciniglio, age 18, works. Her salary is unknown.
Sister: Alvira Ciniglio, age 15, goes to school.
Sister: Dorothy Ciniglio, age 9, goes to school.

After a careful consideration of the facts and circumstances surrounding this case, it is the view of the War Department that, while the Government driver was negligent in that he was at the time exceeding the legal speed limit of 35 miles per hour in effect at the point where the accident occurred and in that he failed to apply his brakes immediately when he saw the boy first run out upon the highway, the boy, on the other hand, was also negligent in proceeding onto the highway without first ascertaining whether by so doing he would subject himself to danger from approaching traffic, and that such negligence on the latter's part substantially contributed to the accident and the injuries sustained by him, and, therefore, effectually bars his claim for recovery. It is believed that the boy was old enough and possessed sufficient intelligence to be aware of the danger attendant upon walking or playing on a heavily traveled highway and, hence, chargeable with the obligation to exercise a reasonable regard for his own safety under such circumstances. The Department is accordingly constrained to recommend that favorable consideration be not given to the proposed legislation.

The fiscal effect of the bill is manifest.

The Director of the Bureau of the Budget in a letter to the War Department dated June 16, 1944, concerning the report on this bill, stated:

“It is noted from the report that the Government driver admits that he was driving 40 or 50 miles per hour in a 35-mile speed limit zone; that he failed to apply his brakes immediately when he saw the boy first run out upon the highway; and that the boy, who is somewhat mentally subnormal, was only 11 years of age at the time of the accident.

"Under the circumstances, I feel obliged to advise you that while there would be no objection to the submission for the consideration of the committee of such report as you may deem appropriate, this office would interpose no objection to an assumption by the Federal Government of responsibility for this accident.” Sincerely yours,

HENRY L. STIMSON,

Secretary of War.

J. M. MacKELLAR, M, D., F. A. C. S.,

Tenafly, N. J., January 10, 1944.
Louis CERNIGLIO:
To professional services...

$370. 00 Open reduction of fracture of humerus with application of bone plate... 250. 00 Treatment of factured skull, 12 spinal taps...

120.00 Certified correct and just, payment not received.

J. M. MacKELLAR.

THE ENGLEWOOD Hospital Association,

Englewood, N. J., September 7, 1943.
Mr. Louis CINIGLIO,
227 East Ruby Avenue, Palisades Park, N. J.

To the ENGLEWOOD HOSPITAL Association, Dr.
For care of Louis Ciniglio. Ward or room No. 217. Patient No. 121,448.
June 19 to Aug. 18:
60 days' board and care, at $4.50.

$270. 00 Operating service...

10. 00 Ace bandage.

. 60 X-ray service.

65. 00 Medicine..

5. 50 Laboratory service: 20 urinalyses.

$30 2 cultures

5 9 blood counts.

18 1 blood count.

5 1 plasma protein..

5

63. 00

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414. 10 Aug. 13 to 18: 5 physiotherapy, at $2.

10. 00 Total.

424. 10 I hereby certify this to be a true and correct statement of account, no part of which has been paid. (SEAL)

AINONA E. WUSTHINES,

Acting Superintendent.

THE ENGLEWOod Hospital Association,

Englewood, N. J., August 30, 1943.

CINIGLIO, LOUIS, AGE 11 YEARS (BIRTH DATE NOVEMBER 1), 227 EAST RUBY AVENUE,

PALISADES PARK, N. J.
Father's name: Louis, born in Italy.
Mother: Carmela Savarese, born in Italy.
Dates in this hospital: June 19, 1943, 4 p. m., to August 18, 1943.

Diagnosis: Compound comminuted fracture of right humerus, lower third, fracture of right scapula, fracture of skull, base, laceration of brain, contusion and abrasions of frontal area of head and of left elbow region.

Summary: Patient semicomatose on admission. Course: After repeated lumbar punctures, symptomatic treatment for head injury; right arm was repaired by insertion of a Lane plate; following healing of the arm physiotherapy was started. Child improved after a long hospital course without any complications. History: Complaint-pain, immobility right arm and shoulder, semicomatose condition, multiple bleeding points.

Child was struck by a car and brought into hospital by driver who stated that child was unconscious when found. A short time later child became excitable but never rational. Patient has not voided nor defecated since in the hospital.

Usual childhood diseases. History of fracture of right arm 3 years of age. Mother and father living and well.

Physical examination: The patient is a young white boy overdeveloped for his age. He is thrashing wildly about on the table. When questioned he responds only with a grunt. He seems to have difficulty with respiration, stopping short before the end of inspiration. No cyanosis is evident.

Head: Multiple abrasions.
Ears: Right canal fill with blood which seems to be coming from the inner ear.

Pupils equal and regular, react to light and accommodation. Extraocular movements normal.

Teeth: Intact, no pharyngeal bleeding. Neck: Good motion, no deformities. Thorax: Pain in right upper thorax, lateral; no deformity felt. Lungs: Limitation of inspiratory excursion and bronchial rales, no parenchymal rales; no change in breath sounds; heart not enlarged; regular sinus rhythm; no murmurs; sounds of good quality.

Abdomen: Soft, symmetrical; no tenderness or spasm; liver and spleen not enlarged.

Genitalia: Normal for age and sex. Extremities: Multiple abrasions; right scapula, pain, deformity of lateral border; right scapula, deformity, pain, immobility, lower half seems involved.

Neurosis: Unsatisfactory, patient uncooperative.

OPERATION

Date: July 14, 1943.
Surgeon: Dr. J. M. MacKellar, Dr. Caroline Burpeau.
Preoperative and postoperative diagnosis: Fracture of right humerus.
Operation: Insertion of Lane plate.
Anesthesia: Gas-oxygen-ether.
Preparation: Merthiolate.
Pathology: Separation of the distal and proximal fragment of the right humerus.

Procedure: About a 4-inch anterolateral incision was made through the skin, separating the muscles down to the bone. A periosteal elevator and bone clamp were used to unite the distal and proximal fragments. A four-screw Lane plate inserted, and 4 grams of sulfanilamide powder sprinkled into the wound. The incision was closed with black silk sutures. An anteroposterior W splint applied.

Condition: Good.
Medication: Four grams sulfanilamide powder.

PATHOLOGICAL REPORT JULY 14, 1943
Source of specimen: Humerus.
Gross: Specimen consists of three pieces of bone 1 to 2 centimeters long.
Diagnosis: Bone.

Dr. FRANCIS J. Fadden, Pathologist.

ROENTGENOLOGY RECORD

June 19, 1943, right arm: There is an irregular fracture of the lower third of the shaft of the humerus about 7 centimeters up from the elbow joint, the fracture surfaces are not in apposition, poor position with angulation. Also, an extensive fracture of the lower portion of the scapula just seen on the roentgenogram edge, poor position.

July 2, 1943, right arm: Fracture of the lower end of the humerus as previously described. The fracture surfaces are not in apposition, the lower fragment is displaced laterally and forward and is overriding nearly 1 centimeter. The fragments are in poor position. The stripped up periosteum shows some callus of calcium density forming on the under surface of the periosteum.

July 9, 1943, skull: There is a linear fracture of the parietal bone, left side, the fracture line is perhaps 2 to 3 centimeters in length and extends down to the parietal-temporal suture but apparently does not cross the suture line into the temporal bone. The line of fracture is seen on the roentgenogram of the right

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