Minutes of evidence of the departmental committee appointed to inquire and report whether the following diseases can properly by added to those enumerated in the third schedule of the Workmen's Compensation Act, 1906 : namely: (1) cowpox, (2) Dupuytren's Contraction, (3) Clonic spasm of the eyelids, apart from nystagmus, (4) writers' cramp.

Great Britain. Departmental Committee on Compensation for Industrial Diseases

Date:: 1913

Credit: Minutes of evidence of the departmental committee appointed to inquire and report whether the following diseases can properly by added to those enumerated in the third schedule of the Workmen's Compensation Act, 1906 : namely: (1) cowpox, (2) Dupuytren's Contraction, (3) Clonic spasm of the eyelids, apart from nystagmus, (4) writers' cramp. Source: Wellcome Collection.

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$14°\December 1912.] some.’ points not already mentioned by the other witnesses. 1540. Will you give the effect of that as shortly as you can P—It is very short. I first of all define it. Isay: ‘“‘ Dupuytren’s contraction is due to chronic * thickening and contraction of the palmar fascia “* of the hand and of the prolongations of this fascia «into the fingers. The fascia becomes slowly and progressively thickened and there is retraction, with ‘the result that the fingers become permanently flexed. This condition most frequently commences in the “ little finger and gradually extends to the ring and middle fingers, which may become so firmly and forcibly flexed that their extension is impossible. In extreme cases the forefinger and thumb may also be affected. Sometimes the disease first affects the third or ring finger, and this appears to have been “ particularly noticed among the Nottingham lace “ operatives.” Then I describe the palmar fascia. 1541. We have had that before P—Yes, I see that Mr. Robert Jones has given that in his evidence. Then I say :—*The disease begins very insidiously “and without apparent cause. The first symptom ** noticed is a hard nodule forming under the skin in the palm of the hand about the position of the most definite transverse crease, and as the disease extends “ the fingers are slowly drawn into the palm of the hand and become fixed and immovable. The skin is free at first, but eventually becomes transversely puckered and the fascia gives a thickened and ‘* nodulated appearance which can be easily felt under the skin. The progress of the disease is painless. * The tendons and their sheathes are unaffected in this complaint. The deformity usually affects both hands, advanced state of the disease than the other.” 1542. (Dr. Legge.) Would it be right to say that the position of the most defined transverse crease is the same as the position of localised pressure on the palm of the hand ?—Not necessarily. I shall amplify that later on. 1543. With regard to the lace-workers ?—I very much doubt it ; but if you will ask me the point later, I think I can answer it better under the heading of “ Lace-workers.” 1544. (Chairman.) What do you say as to the frequency of this disease ?—I have looked up the literature on the subject, and there is’ very little statistical information in medical literature. 1545. It must be agreed that it occurs amongst all classes of the community ?—It is a disease affecting all classes of the community. 1546. That seems to be agreed amongst the authorities >—That is so. I should like to mention under this point, if it would be of any interest to the Committee, that Anderson examined 2,600 adults, mostly in the workhouses of London, and found 33 cases of Dupuytren’s contraction, or a percentage of 1:27. Noble Smith also examined 700 people who were in workhouses in London, and found 70 cases or 10 per cent., and of those 700 people there were 400 women, among whom were found 15 cases of this condition, thus leaving 55 cases in the 300 men. 1547. A very large proportion ?—A very large pro- portion. Then De Lom, who was a surgeon in the British Army about 30 years ago, made some observa- tions on this point and examined some 203,000 soldiers whose ages varied from 17 to 35, and he only found three cases. In Keen’s Surgery it is noticed that of 1,000 ex-soldiers who were examined, 39 were found to show symptoms of the disease. 1548. Older men who had probably adopted various new occupations ?—That is so—retired soldiers. The other figures are taken from Anderson’s published lectures on the subject. I should also mention that this disease is not known in India and Japan. 1549. By what authority do you say that ?— Anderson, who gave his lectures before the Royal College of Surgeons i in 189i / 1550. And he said so ?—-Yes, he said so; and he had worked in India for some years. 1551. Is that Dr. Anderson of St, Thomas & P Yes, Dr, William Anderson. n . . © a iw wit * « “ ”~ 8 « n nw Ee a 5: a 8 8 * 6 re re n (Continued. (Dr. Collis.) He was a great Japanese authority. « 1552. (Dr. Legge.) He lectured on Japanese art; I believe ?—Yes; and he had had experience’ both in Bengal and Japan. He said it was an unknown disease there. “Men are more commonly affected “ than women, and the disease may be said to be one ‘“ of middle and late life, although cases have been ** occasionally recorded as occurring in early manhood ‘* and even childhood.” 1558. (Chairman.) Now as to the causation PI do not wish to go over the points that have been already covered by Dr. Collis’s and Mr. Hatock’s report, but I think this subject can be discussed under four headings. 1554. What are those headings ?—First, heredity ; second, gout and rheumatism; third, traumatism ; fourth, chronic and localised pressure on the palm of the hand; and I think I may add, fifth, the bacterial origin. Withregard to heredity, all authorities admit that heredity may be an important factor in ‘the etiology of this complaint, and a family predisposition is well recognised. I have heard part of Dr. Black’s evidence, and he referred to these cases. I do not think he referred to Keen’s cases. At any rate Keen found the factor of heredity in 50 out of 190° cases: In three cases it has occurred in three generations, and once in four generations. With regard to gout, according to Dupuytren himself and Keen, it is often associated with Dupuytren’s contraction, and both Adams and Sir William Gowers found a history in nearly all their cases. Adams found the disease more common among the professional classes and butlers and indoor servants than in those who had’ manual labour. That is probably because his practice was in the West Hind of London. I think he was surgeon to St. George’s Hospital. st 1555. The Royal Orthopedic ?—Yes. I do not attach much importance to this except to emphasise the fact that it is found among ali classes, and in Dr. Collis’s report there are statistics given with regard to rheumatic and gout diathesis amongst the lace- minders and tinplate workers. Hrichsen regarded gout and rheumatism as having an important bearing on the cause of Dupuytren’s contraction, and Lockwood has demonstrated the presence of uric acid crystals in a thickened fascia in a case which he dissected. On the other hand, Dr. Luff believes there is no connection between gout and this disease, and he never found ~ gout deposits in the thickened fascia: 1556. (Chairman.) Before we pass from that, what conclusion do you draw from the fact that Mr. Lockwood found uric acid in the thickened fascia ?—The only point I wish to make is that the subject was evidently a gouty subject, but I do not press it beyond that point. I have looked up Mr. Lockwood's original paper in the Transactions of the Clinical Society, in which he says that he found deposits of gout in other parts of the body and actually in the same hand. ». » 1557. (Dr. Legge.) If uric acid was found in tissue removed from a person who was going to apply for compensation—supposing the disease were scheduled— would that not influence the judge’s mind against it being due to his employment ?—That is a point that I would like to consider later on, because one has to consider in the first place whether this disease is due solely to pressure, or whether in, say, a rheumatic or gouty person, who for the sake of argument we will say is predisposed to the complaint, the pressure does not aggravate the condition. One has to look at it, I think, from two points of view. So that in a gouty case, if the Committee were to decide that irritation were the cause of Dupuytren’s contraction, I think it is common knowledge that in a good many cases there is this gouty diathesis, I think it could be argued that in a gouty subject pressure would aggravate the condition, and if the condition is produced in any way by pressure, the man would be able to make a successful application for compensation. 1558. (Chairman.) I am inclined to agree with you ?—I put it inthis way aftermaking these premises. 1559. Then you deal with a possible cause in traumatism ?—I should like to say I have found in cases that -have come under my own notice, both$

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