A diagnosis of manganism is "not cast in stone" and there is a great degree of uncertainty among those dealing with the disease, a labour department inquiry investigating several cases of manganese poisoning heard on Wednesday.

Dr Susan Tager, a neurologist who specialises in movement disorders, said: "There is uncertainty among all of us working with patients suspected of manganism.

"There is uncertainty about who has the condition and about who hasn't got the condition. We do not have the luxury to say beyond reasonable doubt."

Tager, who examined several of the workers from the Assmang ferromanganese smelter and diagnosed some of them as having the disease, was testifying before a Department of Labour inquiry at the Cato Ridge Country Club to investigate several alleged cases of manganism.

Not set in stone

The hearings form part of an investigation launched by the Labour Department in November 2006 when five workers were reported to be suffering from manganese poisoning.

Manganism is acquired by overexposure to airborne manganese and is a disease that affects the sufferer's central nervous system, leaving them with symptoms very similar to Parkinson's disease and multiple sclerosis (MS).

Tager said that when a neurologist made a diagnosis, "that opinion is not cast in stone. That opinion may change if there is new information."

She added that there was a wide range of symptoms and signs that individually could also be associated with other diseases. There are no laboratory or radiological (x-rays and scans) tests to prove the disease.

Tager, who is based at the University of the Witwatersrand Donald Gordon Medical Centre, said that most of her patients that she had treated with movement disorders were sufferers of Parkinson's Disease or similar diseases.

She said that while medical literature abroad had indicated a similarity between manganism and Parkinson's, it had been noted in South Africa that the main problem had been "to distinguish manganism from normality or from other diseases."

In her statement read out at the start of the hearing, Tager said that she had first been asked in March 2006 to examine two of Assmang's employees.

Later more employees were referred to her and in February 2007 she examined 17 employees in Pietermaritzburg.

She said that she was later asked to join a medical panel to examine the problem at Assmang, but that from August 2007 all contact from the company and its referring doctors ceased.

"I don't know why"

"I don't know why things turned out the way they did," she said, when asked why the company had stopped using her services.

The start of Wednesday's proceedings was interrupted over arguments about the presence of a witness who had criticised Tager's manganism diagnoses; as well as a power cut.

Richard Spoor, the attorney representing the affected workers, said that Dr Murray Coombs, who had written a report apparently criticising Tager's conclusions, would have "the temptation to modify his evidence in light of the evidence given (by Tager)."

Willem le Roux, the attorney representing Assmang, pointed out that several other witnesses had previously been present at previous sittings of the inquiry before they gave their testimony.

Coombs, an occupational health practitioner from the company Elixir Corporate Health, contracted by Assmang, was eventually allowed to remain in the hall Tager's evidence was heard.

Sapa

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