On appeal from Workmen's Compensation Division.
The petitioner was awarded five percent of total permanent disability resulting from a contact dermatitis found to have been caused by her employment with the respondents as a domestic. The respondents question the propriety of the award. Major among their criticisms of the judgment is the claim that the evidence does not support the finding that her condition was caused by an exposure while in their employ. Allied with this proposition is the claim that the evidence fails to establish either an accidental occurrence or a compensable disease within the contemplation of the Workmen's Compensation Act.
At the time of her mishap the petitioner was serving as a day worker in five different households each week, this routine having existed for many months. A variety of usual domestic tasks fell to her lot in these homes, washing dishes and windows, vacuuming and waxing floors, washing and cleaning utensils, and taking care of children. The use of soaps and detergents was required in her work. The respondents had a number of copper pots and pans, and on the day in question, Friday, July 2, 1954, petitioner cleaned them with a preparation named "Copperbright." It appears that this was the first time she had ever used this substance, though it had been in the respondents' house for about a year. At about 7 P.M. that evening, after she had returned home, her hands commenced itching, and on the following morning there were blisters on both hands and also on her arms and face. She then went to the Newark City Hospital where a dressing was applied, and on the following Monday a worsening of the condition prompted her to seek the advice of her physician, Dr. Schramm, who diagnosed an acid burn. She failed to associate the use of the Copperbrite with her condition until after speaking to Mrs. Beitler on Monday,
following her visit to Dr. Schramm, and though she and Mrs. Beitler are in disaccord about the details of the conversation it seems clear that they discussed the possible causation of the condition and that Copperbrite was mentioned in that regard.
Dr. Shapiro, a dermatologist, testified to a nexus of causation between the use of the cleaner and the condition found by him on the occasion of his first examination made two weeks after the outbreak of the disease while the patient was still displaying acute symptoms. His conclusion rested upon the theory that the use of Copperbrite was a final insult to skin whose structural integrity had been undermined by the steady and prolonged immersion of her hands in water containing various cleaning agents used in her employment as a domestic. His determination, he said, was based upon a number of clinical factors, which, when evaluated in the light of his experience, made it probable that this product had been the effective cause of the ailment. Of importance he declared to be the factors of history, findings, time relationship, and the course of the disease.
There is nothing in the respondent's case to gainsay the petitioner's assertion that she used the allegedly offending substance on the day in question. In fact, Mrs. Beitler, who was not at home for most of the day and thus had no personal knowledge about the incident, frankly declared that she was prepared to accept the petitioner's account since she had found her to be truthful and trustworthy.
Substantially considered, the respondent's proofs were limited to expert testimony by a skin specialist, Dr. Fanburg, that patch tests done with Copperbrite, in full strength and in solution form, on her thigh, were entirely negative. The failure of positive reaction within a period of 48 hours convinced him that this substance was not a primary irritant. And it was his conclusion that, inasmuch as the injury complained of had asserted itself within a comparatively short time after her exposure to Copperbrite, the tests demonstrated that the substance did not produce the claimed result. He expressed the opinion that her condition was due to some
other irritant to which she had become sensitized and that the place and time of the harmful contact could only be a matter of speculation. I take the view that the patch tests, standing alone, furnish no aid in the solution of our problem. Their performance on a part of the body that had not been subjected to the same conditions as the petitioner's hands deprives them of any independent force in the factual situation here found. Aside from Dr. Shapiro's general observations that the patch tests offer at best only a complementary means of diagnosis, and, even then, that their usefulness is considerably diminished where a negative reaction ensues, I am impressed by the logic of his holding that they form no criterion for judgment unless the control area has been exposed to the same predisposing forces as were the hands. It is significant to note that both dermatologists agreed that it would have been extremely hazardous to test her hands with the suspected material.
I am convinced that the petitioner's claim is well founded. It is impossible to escape the persuasive force exerted by the assertion of the primary symptoms so soon after she used the cleaning compound for the first time and the steady development of other manifestations that marked the acute stage of the disease. And it is reasonable to accept the theory espoused by Dr. Shapiro that the offending material, though probably not capable of producing harm at first contact with a normal skin, was competent to achieve this result in a dermal area that had lost its protective acid mantle through the continual daily use of detergents.
The respondent's argument that Dr. Shapiro exceeded the facts of the hypothetical question propounded to him in formulating his opinion on causation lacks force. The doctor was furnished with a hypothesis which expressly included the factors that she was employed five days a week in general housework by different employers, and that she had to use various detergents in her work. Because the doctor concluded that the petitioner was constantly immersing her hands in ...