THE COLLIERY GUARDIAN

AND

JOURNAL OF THE COAL AND IRON TRADES.

Vol. CVIII.	FRIDAY, OCTOBER 9, 1914.	No. 2806.

MINERS’ NYSTAGMUS.

An article on miners’ nystagmus appeared in a recent
issue of the Journal of State Medicine, the organ of the
Royal Institute of Public Health, by Dr. Samuel
McMurray, F.R.C.S., ophthalmic surgeon to the
Longton Hospital, Stoke-on-Trent.

On the subject of night blindness, a symptom which
is made much of by most observers, Dr. McMurray says
that personally he believes that if it exists at all it is
only to a very small extent. It is true that the patients
complain that their sight is much worse at night than
in the day, but in bis opinion this apparent loss of sight
is due to the fact that the patient moves from the
radius of one artificial light into that of another. By
this means there is a more or less constant change in
the amount of light falling on the eyes. This in itself
is enough to excite attacks of oscillation. Then again
at night time, if the patient remains in a regularly
illuminated area, such as by moon or star light,
and away from artificial light, in his experience
night blindness is not complained of and will not
be found. He does not think that there is a particle
of evidence to show that clonic spasm should be
considered as a separate disease under the Workmen’s
Compensation Act. Dr. McMurray adds:—“In the
production of nystagmus we must admit that a personal
element is present; otherwise why should it happen
that some men should develop the disease and others
working in almost identical conditions should be free
from it? The determining factor in the development
of nystagmus in an underground worker may be one or
more of the following conditions:—Neurotic tendency,
ametropia, corneal injury, cataract, want of proper
muscle balance. By any of these irregularities the image
of the point fixed is not thrown on the fovea distinctly,
This is a most important point, considering the feeble
light of the surroundings and the intentness of vision
necessary for accuracy in manipulating the pick (in my
own cases I found that of 173 only five were really
ametropic). A large number of cases first become
incapacitated from work as a result of an accident
either to the eye, head, or other part of the body. Very
often the accident which turns a latent into a manifest
case is very slight, but just, sufficient to upset the
balance between capacity and incapacity. In one of
my cases a post fell upon a collier’s foot, producing a
skin wound. He did not go to work on the following
day as his foot was painful, but after working on the
second day following the accident he was compelled to
give up as he was suffering markedly from the effects
of nystagmus. I am convinced that many accidents
happen as the result of nystagmus, even though the
man may not know that the disease is present. The
diminished vision and the blurring of objects may, in
the dim light of the pit, prevent the miner from seeing
clearly, and thus slight accidents may occur. In this
way a vicious circle is started—latent nystagmus,
accident, manifest nystagmus.”

Approximately 20 per cent, of all underground
workers are found to have evidence of nystagmus, but
only 0’29 per cent, are incapacitated; in other words,
nystagmus does not necessarily incapacitate. A severe
attack renders the man unfit for any kind of work;
with a less severe attack he may be unfit for under-
ground work but quite capable of doing useful work on
the surface. A mild attack may not incapacitate the
man in any way; indeed, he may not know that his
eyes are affected in any way. The curious thing about
incapacity from nystagmus is that although a miner
may not give up work until even a person who
has no previous training can tell at once that some-
thing is wrong with his eyes, still, once he has been
incapacitated and has tasted the fruits of compensation,
it is with much difficulty, even after all traces of the
disease have disappeared, that he can be persuaded to
resume any kind of work. Dr. McMurray does not

consider that the men are malingering, but that they
have become so imbued with the idea of their own
illness that they are incapable oi trying. He suggests
that all underground workers should be examined at
short intervals, say every three months. By this means
nystagmus could be discovered in its early stages, and
the miner transferred to surface work for as long as
necessary till the disease bad disappeared. This would
be a costly business for the collieries, but in the end
there would be a large saving. He sees no reason why
miners who need them should not be allowed to wear
glasses. Not only would one of the causes of nystagmus
be corrected, but many slight accidents to the eyes be
prevented. Finally, he urges the importance of the
miner starting surface work as soon as he gives up the
pit work. In this way the time during which he is
incapacitated will be shortened by his thoughts being
deviated from his own depressing condition, and also
by using his eyes in a good light.

A Belgian View.

A paper was read not very long ago before the
Belgian Association of Social Medicine, by Dr. Rutten,
of the Ophthalmic Institute of Liege and a well-known
authority on nystagmic complaints, who is strongly
opposed to the view that light plays a role in the
causation of nystagmus. The paper took the form of
replies to certain categorical questions regarding the
prevalence of the disease in mines.

Dr. Rutten said it was altogether impossible to state
definitely the number of miners affected by the malady
called erroneously, from its principal symptom,
nystagmus. The use of the word was erroneous
because it was not an affection localised to the eyes
only, but a general psychometric and nervous complaint,
which manifested itself in the muscles of the body as
well as in those of the eyeball. It was in brief a kind
of multiple myoclonia, of which the cause is a toxic
organic cerebral lesion, provoked by fatigue, similar to
those encountered in other cases of industrial poisoning,
as by mercury or manganese. It was possible, however,
to distinguish absolutely this cerebral nystagmus from
‘ vestibular ” nystagmus. Properly speaking, there,
should be comprised in the statistics, a thing unfor-
tunately impossible, all those in whom a nervous
affection betrayed itself in any external phenomenon,
not only ocular. According to Dr. Rutten, nervous
derangement is very quick to establish itself in workers
in the mine, and more particularly in hewers, since the
latter are more subject to ocular and general fatigue,
The tremor may remain concealed from view for a time,
but in the case of the facial muscles it is frequently
sensitive to the touch. Slight clonic spasm can be
detected by the ophthalmoscope, and in all cases the
latent disease manifests itself when a small dose of
strychnine is administered.

As to the prevalence of the disease, as compared with
former years, Dr. Rutten considers that the proportion
of miners affected by the “ dance of the eyes,” which is
the chief symptom that has given its name to this
nervous derangement, but does not constitute the
essence of the malady, has not sensibly changed since
1870. Until laws protecting labour were introduced,
the worker continued to tire himself up to his physio-
logical limits. Without doubt, if the cause of the
accumulation of special fatigue were to be banished, it
would be possible to predict that this disease would soon
disappear as a trade affection. Excess of duration,
excess of intensity, and excess of speed were the
principal causes of this fatigue. In the case of the
miner this was accentuated by the unnatural attitude
which he was compelled to assume in the workings.

Dr. Rutten says he has no doubt that auto-intoxica-
tion is the cause of nystagmus, since it alone can explain
the special tremor which is the sole appreciable
symptom, In support of his theory—that the unnatural

attitude of the miner is the predisposing cause—Dr.
Rutten observed that it was not a question so much of
the intensity of the lighting, but of the thickness of the
seams. In this connection he pointed out that tall men
are more quickly affected. He oppos* d the light theory
on the ground that the disease is absent in metalliferous
mines and even in collieries in which the miner can
maintain an upright position, as in Eastern Europe.
Prof. Barany, he said, bad never observed a case of
nystagmus before coming to Liege in 1913, and in the
thick seams worked in Austria, nystagmus is unknown.
If insufficient lighting were the cause, everybody would
be affected. The animals in the pit would be affected
as well as the men. . Mr. Hubert, the Minister, asked4
with much justice in 1909 why the putters, whose duty
of pushing the tubs makes no demand upon the eyes,
should be affected in a serious proportion.

Result of Abnormal Labour.

Dr. Rutten thinks it is a mistake to believe that some
miners, submitted to the same conditions, escape the
evil influence of abnormal, intense and prolonged labour
upon the nervous system. The only thing is that they
may not show the eye tremor, which does not constitute
the essence of the malady. The centre of the evil is in
the brain, and a partial degeneration of the nerve cells
may pass unnoticed. Contrary to Dr. Dransart, Dr.
Rutten believes that organic toxic lesion may result in
death, as cerebral haemorrhage is by no means rare
amongst young nystagmic coal miners.

In common with nervous disorders in general, there
can be no question of distinguishing the degrees of
gravity in this disease. A nystagmic subject affected
with trembling of all the limbs will continue his work,
whilst a degenerate who has not even the oscillation of
the eyeballs will declare himself unfit for work. Certain
nevroses cannot remain below ground, and yet are unable
to describe the symptoms that affect them. It is a
question of resistance, energy—in other words, of will.
In the ocular derangement everything depends on the
method of adapting, of accommodating the brain to it;
a second nature is created, so to speak. Dr. Rutten
considers that no nystagmic subject should be allowed
to continue at work underground. On the other hand,
a nystagmic subject wounded in the eye will be cured as
rapidly as others injured in the cornea.

Nevertheless, it is not absolutely necessary, in Dr.
Rutten’s opinion, that the nystagmic subject should be
permanently barred from work below ground, although
this may be imperative in extreme cases. As to the
remedies, he thinks these can only be preventive in nature;
a reduction in hours and ample periods for repose are
indicated. The payment of miners by the day instead
of by the ton would surely, in his opinion, eradicate the
malady. He is an advocate of “ Taylorism ” and the
physiological study of labour. He is in agreement also
with the Swedish savant Ling, who believed that to
every action performed in an evil position pernicious
results must correspond. Man is not constitutionally
constructed to work in a prone or hunched attitude, nor
to walk with a bent frame or head. Some trouble in
the “ corporal harmony ” will result, and nature will
avenge these infractions of physiological laws.

In the course of discussion upon this paper, several
medical experts expressed dissent from the views held
by Dr. Rutten. Dr. Glibert pointed out that no cases of
nystagmus had been observed amongst other workers
who adopt “ vicious ” positions, such as the workmen in
glue and gelatine factories. Dr. Rutten’s answer was
that the “ vicious ” position of the collier was permanent,
whilst in the case of other workers it was intermittent.
Dr. Glibert said with reference to the figures supplied
by Mr. Libert in 1910, showing that the proportion of
nystagmic subjects was 19’9 per cent, amongst the
workers on the day shift, as against 5’9 per cent,
amongst those on the night shift, that the former were
paid by the piece and the latter by the hour, and the
work of the former, who were colliers, was more intense
than that of the latter, who, being repairers, worked in