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
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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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    wv 12 October 1912. ] anybody one comes across who happens to be affected, and I have found one or two in the upper classes, and I have always found there was a history of hard usage. But those cases are so few that I do not quote them in the report. They are not sufficient to go upon, but they naturally strengthened the opinion I had previously formed. 43. (Chairman.) Take gardeners. You found some cases amongst them ?—Not myself. Dr. D’Arey Power quotes the pressure on the palm of the hand in digging, and states his opinion: “it is by no means * uncommon in gouty and rheumatic gardeners as ** they become advanced in years.”’ 44, Do you say it is confined to people engaged in manual labour?—No, it is not confined to people engaged in manual labour; but I think personally it is confined to individuals the palms of whose hands have been subjected to injury some time during their lives. On this point I think considerable support. is given to this opinion in the facts stated by Arbuthnot Lane that the disease is almost entirely limited to the male sex. Out of 90 hospital cases you will notice only 11 are females, and of those 11, 6 were under the age of 20. Even out of these 6, 2 were definitely stated to be congenital cases. I do not see why there should be this disproportion between the occurrence of the condition in the two sexes if we had to consider that such diatheses as rheumatism and gout are the important determining cause, which must exist much more evenly between the two sexes. The proportion, taking those over 20 years of age, of 5 women to 80 males seems to be about the proportion we might anticipate if occupation with rough usage of the hands was a determining cause. 45. The occupations in the hospital cases are very various, are they not ?—Very various. 46. (Sir Clifford Allbutt.) What is your percentage ‘of congenital cases; it is very small, is it not ?—Yes, ‘it is small: 47. It is perhaps negligible, is it?—Not quite negligible. In the records of 90 hospital cases infor- mation is given of four congenital cases, and during this inquiry one case, aged 42, with both hands involved, was seen, in which the condition was known to be present in early youth. I suppose if one wished to theorise on the point of how congenital cases occur, they might be due to intra-uterine injury, such as may result in the amputation of a limb. 48. (Chairman.) Of course the pressure in these different occupations varies tremendously, does it not ? —Yes. 49. (Sir Clifford Allbutt.) There is something in the kind of pressure ?—Yes, I think the localisation of the pressure. 50. Would any pressure whatever cause it, or must it be a pressure of a particular kind, a particular kind of tool for instance?—I do not think it would matter whether it was wood or iron which was exerting the pressure. 51. (Chairman.) But a brush would be enough, would it?—If the pressure were sufficiently heavy. Some people would react more than others as they obviously have in the lace trade. I think undoubtedly there would be a predisposition. . The examination of the cases shows that. So that you may say a less pressure would cause it in one individual than would _be required in the case of another individual. 52. There were bill posters and painters among the hospital cases. The cause there apparently would be the brush ?—It might be the brush; but feeling doubtful on\ that point, in dealing with the hospital patients _I have not ineluded such occupations as those, as cases in which the occupations would expose them to chronic localised pressure. But I think there are several trades among the hospital cases which in our report we have treated as not specially exposed to localised pressure in which after all such pressure may occur. _ Besides the bill posters and painters, there was a _ signal fitter who probably has to work signal levers up and down when fittingthem. But I am not absolutely sure on that point. Printers also might have localised pressure in their work. [Continued. 53. (Judge Ruegg.) What would probably be the particular operation which would subject a printer to pressure ?—He might be a hand printer, or he might in some cases be starting and stopping the printing machines, in which case there might be levers, as there are in the lace trade. 54. (Dr. Legge.) Do you think in the case of the printer, keeping the hand in a contracted position in taking up the type would be sufficient to account for it?—That would exert no localised pressure on the hand, and would place it in the same category as the clerical workers. 55. (Judge Ruegg.) Just following out that question I happened to be told by a lady who visited cotton factories—I think it was in Lancashire—that there are people called twisters who continually twist the thread round their fingers, who suffer from a similar con- traction ?—Yes. I have not seen any of those cases or followed the exact way in which the individual in question carries on his work. It is alittle hard for me to give an opinion there. I have not had a definite case brought to my attention, so that I could see the individual at work. 56. (Chairman.) Are there conditions which are analogous to Dupuytren’s contraction—for instance, arthritis, beat-hand and hook-hand?—Difficulty . of diagnosis would scarcely arise where contracted fingers occurred associated with some general disease. I have seen a case of contracted hand due to rheumatic arthritis. The general condition of the patient made the diagnosis clear. Hook-hand, also, occurs in certain nervous diseases, but the absence of fibrous bands in the palm of the hands and the presence of the general disease would clearly distinguish such cases from the condition of Dupuytren’s contraction. Contracted fingers may follow upon an acute injury such as a suppurating wound or a whitlow, but in these cases also there are no bands arising from the palm of the hand. In beat-hand it is quite possible that if the inflammation started in the centre of the palm a fibrous band might start and contract as a sequela, and you would get Dupuytren’s contraction. 57. (Dr. Legge.) Suppose the Committee decided on scheduling the disease, could we exclude such cases by careful wording of the condition ?—I do not think you could exclude the sequel of miners’ beat-hand. You might exclude cases in which there is no fibrous band in the’ palm of the hand; but a description, defining it as arising in connection with the fibrous band, would include the sequel of miners’ beat hand, would it not ? 58. Yes, but could you suggest a wording that would meet your view P—‘‘ Contracted hand ”’—that is to say, ‘permanent contraction of one or more fingers “ produced by fibrous bands in. the palm. of. the * hand.” 59. Were all these 90 cases that you found, cases of contracted fingers?’—They were all cases with fibrous bands in the palm of the hand; but the fingers were not contracted in all. 60. In how many were the fingers contracted ?— 61 had only the fibrous bands ; 23 had some flexion at least of one finger, and belong to what I call group 2; 8 had more pronounced flexion of the fingers; and 28 belonged to group 4, in which one or more of the fingers is totally flexed. 61. Permanent contraction P—Yes. 62. And were they incapacitated from work, or how many that you saw were incapacitated ?—Those I saw at work were carrying on their employment and were not totally incapacitated. All the cases which I saw that were grouped in class 3 and class 4 are shown in Appendix I. There were 35 cases in all. Of these nine said that their condition had no effect upon their working efficiency, and one man complained not of the effect upon his working efficiency, but that he now could not earn money as a clarionet player, which he used to do in the evening. All the remainder said that their earning capacity was more or less affected, and in some cases they had been compelled to leave the trade on that account. 63. Could you give us the number ?—Of those who left the trade ?