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. ] 55 coin (Continued. 1662. Take another instance, bunions, on the first metatarsal; that is generally bi-lateral. But there need not be at all the same pressure on the two feet ? —That is so. But 1 think there are other factors in the formation of bunions besides the point that it is a bi-lateral complaint. I think that people who get bunions as a rule are very careless about the fitting of the boots, and as a rule ready-made boots are not made with any relation to any slight difference there may be in the two feet. 1663. But is that any stronger point than the fact that any person who uses both hands, to a considerable extent uses one more than the other ?—I am influenced in my opinion on this by the fact that I have seen cases of Dupuytren’s contraction where the disease is more pronounced in the left hand than in the right, and where, if the complaint were due to pressure, one would expect the right hand to be ina more advanced state than the left. 1664. (Chairman.) In what we may call a right- handed person ?—In a right-handed person. 1665. Will you tell us what occupation that was ? —As a matter of fact it was one of the people to whom I have referred in this list, and he was a tennis player. He could not have got his trouble through his work, but if it were due to pressure one would attribute it to tennis playing. He is a right-handed tennis player, and he had been an enthusiastic tennis player for the last 40 years. It was a very advanced case of Dupuy- tren’s contraction, but more advanced in the left hand than in the right hand. (Dr. Legge.) There are obviously constitutional causes at work there. 1666. (Chairman.) Many players hold one or more balls in their left hand ?—I have considered that point in the question of tennis playing. He has the racket in his hand all the time, and I do not think he would have balls in the hand all the time, and then the ball is a quite soft thing ; there is nothing hard about a tennis ball. Adjourned for a short time. (The Shorthand Writer read the last preceding question and answer.) (Witness.) In that case the man is a sufferer from out. : 1667. (Chairman.) There is another reason, I think, you wish to give us 2—I think the smooth skin of the hands of the lace machine minders indicates that the pressure of friction is not so great as to cause irrita- tion or thickening. On the other hand, in the case of miners, the sensitive area of the skin over the palm is the very part where Dupuytren’s contraction begins. With a miner, where they use their pick the point of irritation is clearly shown, and that is not the point where Dupuytren’s contraction begins. 1668. We have had the opinion of Sir John Hrichsen, Dr. Adams and Mr. D’Arcy Power before ?—Then speaking generally, I say I am inclined to think that the disease is constitutional from the fact that it is sometimes hereditary and often associated with gout and rheumatism and frequently bi-lateral. 1669. I gather that you do not wish to express a strong opinion upon that point ?—I believe the cause is at present unknown. There is no evidence to show that the disease is bacterial in origin. 1670. I think that is agreed. Do you know any- thing about it occurring in the foot °—No, I know nothing about that. I have seen the references to the subject, but I know nothing from my own knowledge. 1671. Then you treat with diagnosis. I should like to hear you with regard to that ?—I say, “ The diagnosis “ of Dupuytren’s contraction is easily made. The « eonditions with which it should not be confused are « beat hand, but the after effects of the latter con- “ dition, that is the thickening of the palm with a little « flexion of the fingers, might be mistaken by the in- “ experienced.” For instance, suppose a man were to leave an industrial district and go to a district where the doctor had not seen either beat hand or many cases of Dupuytren’s contraction, he might think that a case of beat hand was an early case of Dupuytren’s, contraction. 6: . 1672. You think a doctor with experience in both these diseases would easily diagnose, one from , the, other >—Yes; but I should like to say. this with, regard. to the evidence I gave three or four’ years ago before the Select Committee. At that time I expressed the opinion that Dupuytren’scontraction and beat hand were the same thing, and I did it for thisreason. The cases. of beat hand in North Staffordshire were very few, and some of the miners who had Dupuytren’s contraction called it beat hand, and being not a technical and, medical expression I accepted the term which they,, applied. 1673. It is quite clear they are not the same thing 2. They are quite distinct. 1674. (Dr. Legge.) And that disposes of what, you. said in reply to Sir Clifford Allbutt when you gave evidence about beat hand?—Yes; that explains, the. reason that I really confused the two conditions., -.In beat hand the trouble is deeper than in the palmar. fascia, and the symptoms clear up in a comparatively, short time. 1675. (Chairman.) Nor would there be much trouble in distinguishing it from congenital contraction 2— That isso. There would not be any difficulty in con-, genital contraction or contraction of the fingers due to injury of the flexor tendons. 1676. Have you considered the question of the treatment at all?—Yes, I have considered it, and I have had practical experience on this point. 1677. Do you know the operation which is called multiple tenotomies ?—No ; one does not touch the ten- dons at all. It is multiple incisions of the thickened palmar fascia. It is quite distinct from multiple teno- tomies. : 1678. It was called multiple. tenotomies by’ Dr. Jones, perhaps for want of a better name ?—I should prefer to call it multiple incisions of the thickened palmar fascia. 1679. (Dr. Legge.) Sub-cutaneous ?—That is so. 1680. (Chairman.) Have you ever operated in that way yourself ?—Yes, I have. 1681. Did you find it beneficial ?—Yes, 1682. Dr. Jones suggested to us that, for the earlier stages, to keep the fingers extended was sufficient ?—I have not had any personal experience of that, but I know that that is so. 1683, And he further suggested that that treat- ment could be adopted by extending the fingers at night without interfering with the man’s occupation ? —That is so. 1684. As a matter of fact, I suppose you rarely see them in the first stages ’—That is so. One only sees them in the first stage when patients come for examina- tion for accidents or in the ordinary way for other complaints. | . 1685. Do you find that the workman who, jis operated upon in the hospital is able to work again in any kind of employment ?-With regard to the treatment of working men for Dupuytren’s contrac-: tion J should like to say this: that in those bad» cases where operation is required the operation is performed at the hospital, and then they go home or to their own club doctor or to no doctor at all, and they are not under sufficient observation for the operation to turn out all right. 1686. With regard to the extent of the disease: causing incapacity to work, we have heard a good deal about that. It is suggested in the first stage it does; not interfere at all. We have certain plates showing the first, second, third, and fourth ?—Yes 1687. In the second stage it interferes to some: extent ?—Yes. 1688. But it is not until it arrives at the third and fourth stages that it really causes incapacity for work, aud sometimes men even arrive at the third stage without causing incapacity for — work, We had a man who was working at the third stage >—That is quite possible. JI should like to say one thing about malingering. I heard Dr. Black’s evidence on the point of the complaint of pain. ‘There can be no possibility of shamming in this disease except

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