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.] gout and rheumatism in seyeral of the cases. With regard to traumatism, I find that Mr. Arbuthnot Lane is the only writer who suggests seriously that this condition might be set up as a result of trau- matism. But even he does not appear to be very emphatic on the point, because he says, “It would “ seem in some cases to be started by a wound in the * palm.” In connection with this, Mr. Anderson; in his lectures before the Royal College of Surgeons, describes a condition which he calls false Dupuytren’s contraction, which he attributes to traumatism; and although when I wrote out my proposed evidence I had not referred to Mr. Anderson’s lectures, it seems that some of my remarks really coincide with what he says. I will not refer again to Dr. Collis’s report, because that is already referred to, except so faras to say this—that in my opinion it does not appear to be clear that traumatism has any effect at all upon pure cases of Dupuytren’s contraction.. I think there are many traumatic conditions of the hand which may lead up to after-effects not unlike Dupuytren’s contraction in some respects, For instance, injury to the flexed tendons may cause a contraction of the finger, or a septic wound in the palm of the hand may result in a thickening of the adjacent tissues (Dr. Legge.) We quite agree with that. 1560. (Chairman.) I. think at the present time all the doctors have agreed upon that ?— Exactly. 1561. There is one question 1 should like to ask you upon that ?—There is one point, if I may mention it, Isay in my report: ‘Then again, when we con- “« sider the many thousands of workmen who meet with * accidents every year, and remember that the hands “ are the commonest seat of injury, it is not surprising * that a history of traumatism should be obtained “in a certain number of cases of Dupuytren’s con- ** traction.” 1562. My question rather arises out of that. It is again with a view to the practical working of the question. Assuming a case of a contraction caused by traumatism brought into the court as a case of Dupuytren’s contraction—caused by a traumatism if you like, and not arising in the employment, otherwise there you would get your compensatable accident; but a ease of a trauma outside the employment, an injury at home or something of that kind ?—I will just make a note, because that brings up another question, if you do not mind my saying so. 1563, Ina contraction caused by trauma outside the employment, and in a case presented in court as a ease of Dupuytren’s contraction, do you think there would be difficulty in arbitrating upon that question ? —It all depends on what view this Committee takes with regard to the causation. Let me put it in this way. If the Committee decides that Dupuy- tren’s contraction is an industrial disease, there will have to be some reasons given for it, and the reasons will be under certain headings such as I have suggested. The Committee would find that the disease, say, was due to the nature of the employment. 1564. lam afraid you are not quite following my question. My question is the difficulty I should have if I had to try the case. It is said, ‘Here is a con- “ traction of the fingers; claim under the schedule “ that is Dupuytren’s contraction; allegation: no, “ that is due to a trauma,” and there is no evidence to show that the trauma occurred at home, at ,the works, or anywhere else. Is there a clear distinction which can be pointed out between contraction due to a trauma and Dupuytren’s contraction ’—Certainly. _ 1565. Do you think there would be no difficulty in showing that to the tribunal?—I do not think that that, would cause any difficulty at all. I do not think really that a pure case of Dupuytren’s contraction is due to trauma, and I think the injuries to the hand due to trauma which cause disablement of the hand resent features that can be differentially diagnosed a Dupuytren’s contraction. ~ 1566. (Dr. Legge.) There would be a scar, would there not, if there had been a trauma ?—There might be or there might not. (1567. (Chairman.) Youthink whether a scar or not they could be distinguished ?—-That is so. a [ Continued. 1568. That was all T wanted to ask on that point. Have you had any experience yourself as to, whether this disease is caused by traumatism 2—Yes, I have. I see hundreds of workpeople who meet with accidents in the course of the year and who contract industrial diseases of different kinds. I have also seen a con- siderable number of cases of Dupuytren’s contraction, and I have never yet been able to trace any connection between the two conditions. 1569. That is because when you find the fingers flexed, and the history of a traumatism, you attribute them to a traumatism and not to the disease ?—In the cases I have seen of flexion of the fingers due, say, to an injured tendon, I have found no thickening of the palmar fascia. In cases of beat-hand among miners one often finds a chronic inflammation underneath the fascia without thickening of the actual fascia and without puckering of the skin. 1570. Will you deal now with what you have to say on this important question of chronic or localised pressure being responsible, or the possibility of its being responsible for the disease >—Many writers have expressed the possibility of the disease being set up by the prolonged effect of the pressure of some tool on the palm of the hand. ; 1571. Or the pressure of anything ?—Exactly, or the pressure of anything. This point is specially referred to in the inquiry which Dr. Collis and Mr. Eatock have made. 1572. You consider that the most exhaustive inquiry into the question yet made ?—-That is so, as far as my own investigations have gone. 1573. And you know the conclusion they came to was that the disease is due, I think I may say, entirely to localised pressure ?—In the first place they find that an unduly large number of lace-minders in the Not- tingham district are suffering from Dupuytren’s con- traction, and also that this prevalence has a direct relation (1) to the frequency with which the levers and wheeis of the machines are manipulated, and (2) to the power required to actuate the levers and wheels, and their size, shape and position. 1574, I think the conclusion they came to at the end with regard to the cause of the disease was that it was always due—I am not speaking of the lace-workers now—to localised pressure; in fact I think Dr. Collis, in his evidence before us, went a little further than he did in his report. 1575. (Dr. Collis.) I did.—In the report I do not know that Dr Collis binds himself to that conclusion absolutely. 1576. (Chairman.) No, but I think he did in his evidence before us. He said he was driven more and more tothat conclusion, and the more he investigated the more be came to that conclusion. Ithink Dr. Robert Jones practically said the same thing. Have you had the opportunity of reading his evidence ?—I have read Dr. Robert Jones’s evidence, but I do not think it is quite so definite as that. : 1577. We will not deal with that now. Could you give us generally your opinion? —I would like to say with regard to the percentage of workers that Dr. Collis and Mr. Eatock found at Nottingham, I think that there is a possibility that the numbers may be—Dr, Collis will not mind my saying so—a little inflated, for the reason that I believe they probably went to the factories where known cases existed. (Dr. Collis.) No. (Witness.) Then I am wrong. to me. 1578. (Chairman.) All that question has been gone into ?—I mentioned it as a possibility. 1579. Do you wish to say something about Long Eaton ?—I made two special visits, both to Not- tingham and Long Eaton, to see what information I could gain with regard to the nature of the employ- tment, and I had interviews with Mr. West and Mr. Wardle, Dr. Tressider and with manufacturers of various kinds of lace curtains, and at Long Eaton I was told by two manufacturers, who claimed to be the two oldest in the town, that the disease was practically unknown in that town That was suggested D 2

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