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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phthisis and Dupuytren’s contraction seems to me to be the slow and progressive nature of both diseases. 1720. And also the fact that men showing the very first signs of it long before they are incapacitated may be dismissed ?—That is so. 1721. And there may be periodical examination of workers 2——Yes. I would like to say with regard to the examination for Dupuytren’s contraction, while the opinion of the officials in the various tr des to which this disease might apply might think they would be able to deal with the matter, it is quite a different matter to cases say of fibroid phthisis because a man’s hand is easily seen, and the employer, in many cases, can see the deformity himself without the aid of a medical man. It is not like examining a man’s chest for fibroid phthisis. You do not have to take a man’s shirt off to find whether he has Dupuytren’s contrac- tion or not. 1722. (Chairman.) We had one case, at all events, before us of a man in an advanced stage of Dupuytren’s contraction with both hands drawn over, and certainly who had arrived at the third stage, who said that his employers did not know the state of his hands. He had taken good care that they should not know ?— Exactly ; but if this disease is scheduled, I think it will pe a matter of surprise to find how many people have got Dupuytren’s contraction. One never thought that beat hand was a common disease; but I understand there were a thousand cases last year for which com- pensation was claimed. 1723. (Dr. Legge.) But apart from that, 1 gather also you lay still more stress on your belief that it does not answer the third, at any rate, of those questions that the former Committee put before them before scheduling ?—That is so. 1724. Namely, it is not so specific to the employment that the causation can be established in individual cases ? —That is so. 1725. (Chairman.) In cases of somewhat advanced disease, do you think it would be possible for the court to insist upon an operation being performed, or otherwise stop compensation unless the man undergoes the opera- tion ?—I do not think 1726. We are told the operation is not a serious one and is not a very painful one ?—No, it is not; but there is a chance of recurrence unless the doctor can follow the case up for months 1727. I am not quite sure that you follow me. Do you think it would be a case in which the court could fairly say, “ Unless you undergo this slight operation, compensation must be stopped ” ?—No. 1728. You know that in some cases there is power to do so even now—small cases —Yes; but in a case of Dupuytren’s contraction, I think it might be necessary to amputate one or two fingers apart from the multiple sub-cutaneous incisions of the fascia. 1729. I am not speaking of amputation for the moment; but undergoing the operation of multiple sub-cutaneous incisions ?—There is no risk attached to the operation, and it would not be unfair to ask the operative to undergo this operation. 1730. Do you think in some cases that might lead to recovery 2—In many cases it might with suitable after-treatment. 1731. Then what would you say to the reason- ableness or not of insisting upon the man returning to the same class of work. It is a difficult question for you, because you do not think it arises from the work, but assuming it was established it had arisen from the work, do you think there would be a chance of recurrence from the man going back to that same class of work 2--Assuming it is due to the work, I should say so. 1732. Now you are prepared to give evidence before us on another disease which this Committee has to consider, that is clonic spasm of the eyelids >—Yes. 1733. First, in your opinion is this disease, clonic spasm of the eyelids, a distinct and separate disease from miner’s nystagmus ?—No, it is not. 1734. Is it a sequela of miner’s nystagmus P—] should like to sayit is associated with miner's nystaginus, and is produced in the same way; that it is really a symptom of the same disease. 1735. In other words, that a person suffering from clonic spasm of. the eyelids has one stage of miner’s nystagmus ?—That is so. 1736. If you are right, it is already covered by the Act, is it not ?—I think that great difficulty does arise in some cases. It should be covered by the Act; but I think myself that the disease miner’s nystagmus is most unfortunately called so. It simply refers to one symptom of a general disease. 1737. What is nystagmus ?—The nystagmus itself is simply an oscillation of the eyeballs. 1738. (Dr. Legge.) What is the derivation of “ny- stagmus ” ?—Nvord{w, meaning “I nod.” 1739. (Chairman.) Does this oscillation of the eye- ball lead to a nodding of the head ?—No. 1740. (Dr. Legge.) A nodding of the eyes?—No. If I may be permitted to explain, the old physicians who first noticed the symptoms of nystagmus found it was most commonly associated with children who had nodding heads. Nystagmus is a symptom which is common toa good many diseases, among which may be mentioned Friedreich’s ataxia and disseminated sclerosis, and some congenital diseases of the eye. 1741. But it is by usage attached to this ?—To miner’s nystagmus—when it is prefixed by “ miner's.” 1742. To a disease of which at all events the chief symptom is the oscillation of the eyeballs )—That is so. If I may use an analogy, exophthalmic goitre is a general disease, of which the exophthalmus and the goitre are two symptoms. It is even more fortunate in having two symptoms under one name; but there are other symptoms, such as symptoms of the heart and of the nerves, which are not covered by the name ; and with miner’s nystagmus the name only refers to one symptom, while the disease itself embraces a good many symptoms, one of which is clonic spasm of the eyelids. 1743. Assuming for the moment that the idea is that the only matter before the Committee is whether it should be included—clonic spasm in miners—then, in your view, it is one of the symptoms of miner’s nystagmus ?—That is so; but let me explain the difficulty that at present arises with regard to those eases in which clonic spasm of the eyelids is present and the actual oscillation of the eyeball is absent. If a miner suffering from clonic spasm of the eyelids with some other symptoms, such as giddiness, headache and vomiting, applies to the certifying surgeon for a certificate of disablement, he is often met with a refusal because he has not got the principal symptom of the disease. 1744. Is that only because the certifying surgeon diagnoses wrongly ?—Exactly so. But when one takes the whole of England, Scotland, and Wales one can- not expect certifying surgeons to be experts on every industrial disease, and this is a condition about which very little is known. As a matter of fact there are only two references that I can find in the whole of the literature with regard to clonic spasm in connection with miners’ nystagmus. 1745. But on the other hand, although the certifying surgeon may be mistaken, that is no suffi- cient reason for putting in as a separate disease what is not a separate disease at all, but only a symptom of a disease already included. Would it not be almost making it ridiculous ?—It does make it ridiculous ; and what I venture to suggest is that another name for miner's nystagmus be adopted to embrace all the symptoms so that a miner who is disabled on account of some of these symptoms would be able to apply for compensation with success. 1746. Something of that kind has already been done in the schedule ?—I would like to point out, in the first place, that the disease now known as miner's nystagmus is not only confined to the unnatural movement of the eyeballs, but the symptoms include headache, giddiness, vomiting, tremors, twitching of the muscles and eyelids, and in some cases even wry-neck may be found. 1747. You are speaking of symptoms of miner's nystagmus ?>—Yes; but it will lead up. to the point I

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