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
Licence: Public Domain Mark
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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![COMMITTEE : 12 October 1912.] [ Continued. 16. How long do you say the disease takes to develop ?—Even under conditions favourable to its development, Duypuytren’s contraction takes about twenty years in developing, and when considering the prevalence of the disease in the lace trade, as shown in Table I. of our Report, I’ think all those examined under 40 years of age should for statistical purposes be neglected. If this is done, the figures in this table show that 11:7 per cent. of those aged 40 years and over employed in the Levers branch were affected, 13-1 per cent. in the curtain branch, 13:4 in the plain net branch (but in this branch only two cases had pro- gressed beyond the second stage), 6:4 per cent. in other processes (all in the first stage), 1:2 per cent. in the tin-plate workers, and 0°4 per cent. in granite cutters. I should say that the last two trades are quoted because inquiries relating to other diseases were being conducted simultaneously in these trades, and the opportunity was taken to examine the hands of the operatives for this purpose also. 17. (Judge Ruegg.) Do I understand that we are inquiring at this stage into the advisability of including this disease generally, or only including it in so far as it relates to the lace workers? The reference to us is generally as to the inclusion of the disease ?—Our report has particular reference to its prevalence in the _lace trade. 18. (Dr. Legge.) Still, you became alive during your inquiry to the possibility of its occurrence elsewhere ? —Most certainly, and references are given in the report to its occurrence in other trades. But I am unable to state statistically, except in the two mstances I have just quoted, the extent to which it\does occur in other trades where manual operations are carried on. 19. (Chairman.) It is more prevalent in this trade than any other ?—As far as my investigations go, I do not know of any other manual occupation where the alms of the hands are so frequently made subject to localised pressure by using machine handles. 20. (Judge Ruegg.) Still, it may occur in any occu- pation where there is laborious manual occupation P— If I might suggest, if you consider the advisability of scheduling the disease here and name the processes in the lace trade in which this report shows it is specially prevalent, in the other trades the onus of proof would lie upon the workman before he could make the claim. 21. I am afraid that would be impossible. The onus of proof lies on the workman now in every case to show that it comes within the scheduled disease P— Yes, but if a man has Dupuytren’s contraction and he was working at one of the processes named in column 2, it would be unnecessary for him to do other- wise than prove he has got it. 22. I quite follow, as is now in some cases of diseases ?—Yes. 23. It is shifting the onus ?—Yes, 24. (Chairman.) That is the whole point, is it not, the shifting of the onus ?—Yes. _ 25. (Judge Ruegg.) For example, take Dupuytren’s contraction in miners ?—It might be a sequela of beat hand. 26. (Str Clifford Allbutt.) You have entirely given your attention, I suppose, to collecting positive in- stances ; you have no collection of negative instances, that is to say, of persons not engaged in the use of the hands in this particular way. The disease is quite common, of course, in the leisured classes P—You will see in Table I. that there are some people who are employed in the lace trade in other processes. Those individuals, though using their hands, were not using them on the machine levers in any way. They were such people as bobbin winders, that is to say, the people who were winding the thread on the bobbins and threading them. There were fitters, people who carried the things about the factories, and the men who were employed in punching out the cards for patterns. 27. With any strain on ‘the hand?—Where the machinery is doing the punching there was no par- ticular strain upon the hands. 28. No particular strain?—No. These people’in the column headed ‘‘In other processes in the lace trade’ (five cases) were at an advanced period of life, and all were in the first stage. 29. This occurrence of the disease in persons em- ployed in other processes is a point that we shall have to bear in mind ?—Yes. 30. Immediately you introduce two kinds of causa- tion, you are getting into a difficulty. Now, as to predisposition >—I personally came to the conclusion during the inquiry I was making that although there might be a predisposition in individuals, localised pressure was always the determining cause. - 31. But how are you to know the predominant cause, as to whether it were due to gout or something of that sort in a person who has never used his hands in this fashion at all?—I have rather come to doubt the occurrence of these cases where there has been no pressure at all on the palm of the hand. 32. They are not uncommon I should have thought ? —My final conclusion was that there was always a history in the background, perhaps even forgotten by the individuals, and I know such a case where on inquiry it was found that there had been in past years localised pressure on the palm of the hand. 33. Of course, one cannot exclude it from any history. It would be impossible to prove negatives in that way; but in shaking hands with people who are in classes of life where the hands are not used in manual labour I have very frequently found a con- traction ’—Yes. I found one case exactly like that while I was. making the inquiry. I shook hands with him and I felt the condition. 34. I thought it was fairly common?—He had been in an engineering shop, and he told me his hands had had rough usage. But I have not seen a case or found the history.of a case, except perhaps some of those that were in the hospital (and hospital cases are not very good to quote as illustrations of what you suggest), where there was not great probability of there having been rough usage of the hands. 30. Then have you not come across cases—I think Thave, and not.a few—in which it occurs in both hands, although only one may, or may not, have been used mechanically P—I have not in my mind’ for the moment any such cases; but no doubt your experi- ence is wider than mine. ‘ : 36. (Dr. Legge.) The photographs show it, do they not ?—Yes, where there has been rough usage of the hands. Sir Clifford Allbutt is speaking of the cases where it occurs in both hands, though the injury may only be traced to the hard usage of one. 37. Is that not the case with lace workers ’—They use both hands. 38. But not equally ?—Quite as equally as the prevalence of the cases in the two hands shows. Table II. shows it is distinctly more prevalent in the right hand where one hand alone was affected. There are 47 cases in the right hand to 10 in the left. That would be about what one would expect, considering that most people are right-handed and the extent to which the right hand must be used in excess of the left. You see both hands were affected in 63 cases. 39. (Chairman.) Your view is that localised pressure of some kind is not only the determining cause, but is the only determining cause >—That is the conclusion I came to, although I must say when I started the investigation it was not my opinion; in fact, my opinion naturally was that which I have been taught and brought up to, namely, that it might occur idiopathically without any irritation at all. But I quite came to the conclusion that in every case localised pressure must be exerted to determine it. | 40. (Judge Ruegg.) May I ask what induced you to change your opinion *—Because I never found a case, when I came to speak to individuals, where I did not get a definite history of injury. , 41. But I assume that your examination was chiefly confined to workers ?—It was chiefly confined to workers. 42. (Sir Clifford Allbutt.) That, of course, is my difficulty. Do you put it as any higher than a con- tributory cause ?—I do, I have questioned others outside. Naturally when one is interested in a subject like this, one takes an interest in the condition of](https://iiif.wellcomecollection.org/image/b32182028_0006.jp2/full/800%2C/0/default.jpg)
