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The Mrc Pneumoconiosis Research Unit and the Mrc Epidemiology Unit Wellcome Witnesses to Twentieth Century Medicine POPULATION-BASED RESEARCH IN SOUTH WALES: THE MRC PNEUMOCONIOSIS RESEARCH UNIT AND THE MRC EPIDEMIOLOGY UNIT The transcript of a Witness Seminar, ‘The MRC Epidemiology Unit (South Wales)’, held at the Wellcome Institute for the History of Medicine, London, on 23 March 1999, with extracts from additional interviews conducted by Andy Ness and from a Witness Seminar,‘Pneumoconiosis in Coal Workers’, 9 November 1994. Volume 13 – November 2002 CONTENTS Illustrations i Preface A R Ness, L A Reynolds and E M Tansey v Witness Seminars: Meetings and publications E M Tansey and L A Reynolds ix Introduction Field epidemiology in south Wales: from tuberculosis to non-communicable disease George Davey Smith xv Population-based Research in South Wales: The MRC Pneumoconiosis Research Unit and the MRC Epidemiology Unit Edited by A R Ness, L A Reynolds and E M Tansey 1 MRC Pneumoconiosis Research, 1937–60 3 Reminiscences 9, 11, 12 The MRC Pneumoconiosis Research Unit, 1948–60 15 Reminiscences 31 1954–58 Blood pressure and respiratory surveys 37 The MRC Epidemiological Research Unit (South Wales), 1960–74 39 Reminiscences 66 1964–69 Iron deficiency anaemia studies 70 1968–72 Headache and migraine studies 72 1969–79 Aspirin trials 74 1972–79 Barry–Caerphilly child growth study 76 Statisticians and technical preoccupations 77 The MRC Epidemiology Unit, 1974–90 79 Reminiscences 110 1976–78 School milk supplementation study 123 1976–82 Environmental lead studies 124 1979–ongoing Caerphilly cohort study 127 Biographical Notes 130 Appendix: Collaborators, Caerphilly cohort study 138 Index 139 ILLUSTRATIONS (page 3) Figure 1: Dr Philip D’Arcy Hart in the 1950s. Reproduced by permission of Photographics, National Institute for Medical Research (NIMR). (page 5) Figure 2: Report 243, 1942. Figure 3: Report 244, 1943. Figure 4: Report 250, 1945. Reproduced by permission of the Medical Research Council (MRC). (page 8) Figure 5: Map of the south Wales coalfield, showing the relative incidence of X-ray abnormalities at each of the 16 collieries. Figure 6: Relationship between the rank of coal and relative incidence of X-ray abnormalities at the 16 collieries. D’Arcy Hart P,Aslett E A. (1942) ‘Medical Survey’ in Chronic Pulmonary Disease in South Wales Coalminers. 1. Medical Studies. Medical Research Council Special Report Series 243. London: HMSO, 74. Reproduced by permission of the Medical Research Council (MRC). (page 10) Figure 7: Swiss miner, 1930s, using a power drill. Gessner H, Bühler H. (1950) Die Beurtelung der stauberzeugenden Betriebe. Veirteljahrsschrift der Naturforschenden Gesellschaft in Zürich 95: 126–142. Reproduced from the Reprint Collection of the Pneumoconiosis Research Unit. (page 14) Figure 8: Dust Diseases:Their cause and care. This pamphlet was published by the National Association for the Prevention of Tuberculosis. NAPT copyright leaflet No. 7, 1950. Reproduced from the Reprint Collection of the Pneumoconiosis Research Unit. (page 15) Figure 9: Professor Charles Fletcher (1911–95), 1971. Copyright Keystone Press. Image taken from Smoking and Health Now: A new report and summary on smoking and its effects on health, from the Royal College of Physicians of London. London: Pitman Medical, 1971. Reproduced by courtesy of the Royal College of Physicians of London. (page 16) Figure 10: Dr Philip Hugh-Jones, c. 1980. Reproduced by permission of Dr Philip Hugh-Jones. (page 17) Figure 11: Advertisement in Doig A T. (1949) Other lung diseases due to dust. Postgraduate Medical Journal 25: 639. Reproduced by permission of the BMJ Publishing Group. (page 18) Figures 12 and 13: From a collection of PRU posters, the Cochrane Archive (ALC/3/4/3i-iv). Reproduced with permission of the Cochrane Library, Llandough Hospital, Penarth, Cardiff. (page 19) Figure 14: Residents of Rhoose Farm House, 1958. Reproduced by permission of the Media Resources Centre, University of Wales College of Medicine and Cardiff and Vale NHS Trust, Cardiff. (page 20) Figure 15: Dr Michael Burr and Dr Peter Oldham, Seminar Room at 4 Richmond Road, c.1980. Reproduced by permission of Dr Peter Elwood. (page 21) Figure 16: Professor Archie Cochrane, aged 51, 1960. Reproduced with permission of the Cochrane Library, Llandough Hospital, Penarth, Cardiff. (page 22) Figure 17: (above) A thermal precipitator used for sampling the concentration of airborne dust. Roach S A. (1959) Measuring dust exposure with the thermal precipitator in collieries and foundries. British Journal of Industrial Medicine 16: 105. Reproduced with permission of the BMJ Publishing Group. (below) Sampling head. Hicks D. (1952) The sampling and analysis of airborne dust for control purposes. Geneva: International Labour Office. Reproduced from the Reprint Collection of the Pneumoconiosis Research Unit. (page 24) Figure 18: Mechanical coalcutter, 1930s. Source: Burgess M J,Wheeler R V. (1931) The ignition of firedamp by the heat of impact of coal cutter picks against rocks. Safety in Mines Research Board, Paper No. 70. London: Mines Department.. Reproduced from VII/11 in the Reprint Collection of the Pneumoconiosis Research Unit. i (page 25) Figure 19: Sir Austin Bradford Hill (1897–1991). Reproduced by permission of the London School of Hygiene and Tropical Medicine. (page 26) Figure 20: Dr Stewart Kilpatrick, late 1960s. Copyright: Bassano and Vandyk Studios. Reproduced by permission of Professor Stewart Kilpatrick. (page 27) Figure 21: South Wales. Drawn by Julie Wood, Shiftkey. Figure 22: Dr Bill Miall, 1958. Reproduced by permission of Dr Bill Miall. (page 28) Figure 23: Miner working in a cramped position, 1940s. Source: Capel E H. (1950) Medical problems in coalmining. Nursing Times, June 1950. Reproduced with permission of the Nursing Times. (page 30) Figure 24: Dr John Gilson (1912–89). Reproduced by courtesy of the Royal College of Physicians of London. (page 32) Figure 25: Douglas bag, c. 1930. From Evans C L. (ed.) (1930) Starling’s Principles of Human Physiology. Fifth edn revised. London: J & A Churchill, 500. (page 34) Figure 26: Dr Basil Martin Wright (1912–2001). Reproduced by permission of Photographics, National Institute for Medical Research (NIMR). Figure 27: Archie Cochrane, 1940s. Reproduced with permission of the Cochrane Library, Llandough Hospital, Penarth, Cardiff. (page 35) Figure 28: Using a spirometer to measure lung function in the 1950s.The photograph appears as Plate 11 in Gilson J C, Hugh-Jones P,in collaboration with PD Oldham and F Meade. (1955) Lung Function in Coalworkers’ Pneumoconiosis. Medical Research Council Special Report No. 290. London: HMSO and in ‘The miner’s other blue scar’ by a Medical Correspondent, Western Mail and South Wales News of 3 February 1956. Reproduced by permission of the Medical Research Council (MRC). Figure 29: Hollerith card and sorting machine, 1940s. Source: Cotton H. (1945) Patient Records. The Hospital (April); Reproduced from the Reprint Collection of the Pneumoconiosis Research Unit. (page 38) Chart 1: Studies conducted by the MRC Epidemiological Unit, 1954–1990. Circulated at the Witness Seminar, 23 March 1999, prepared by Dr Andy Ness. (page 39) Figure 30: Number 4 Richmond Road, Cardiff, was the home of the Epidemiological Unit from 1962 until it returned to Llandough Hospital, Penarth, Cardiff, in 1990. Professor Cochrane’s epidemiology course run for the Welsh National School of Medicine had vacated the house in favour of more appropriate space at Sully Hospital. Reproduced by permission of Dr Peter Elwood. (page 40) Figure 31: MRC59/786, 16 October 1959. PRO FD7/1046. Extract reproduced by permission of the Medical Research Council (MRC). (page 42) Figure 32: Receptionist takes details during an anaemia survey, c. 1968. Reproduced by permission of Dr Peter Elwood. (page 43) Figure 33: Gwilym Jonathan in full voice in the Rhondda in the late 1960s. Reproduced by permission of Professor Estlin Waters. (page 43) Figure 34: Fieldwork team for a survey of anaemia, migraine and urinary tract infections, c. 1968. Reproduced with permission of Professor Estlin Waters. (page 45) Figure 35: Fieldwork team for a large survey of more than 5000 women in the Rhondda Fach conducted by Peter Elwood, Ferndale Clinic, c. 1965. Reproduced by permission of Dr Peter Elwood. (page 46) Figure 36:The south-west coast of Hirta, the main island in the St Kilda group. Reproduced by permission of Professor Estlin Waters. (page 47) Figure 37: Fieldwork team for another anaemia study, Ferndale Clinic, May 1968. Reproduced by permission of Professor Estlin Waters. ii (page 48) Figure 38: Janie Hughes as receptionist in an anaemia survey, c. 1966. Reproduced by permission of Dr Peter Elwood. (page 49) Figure 39: Ann Chapman, a haematology technician from the local hospital, Janie Hughes and Estlin Waters above the Rhondda valley during the anaemia study in Rhondda Fawr in the late 1960s. Reproduced by permission of Professor Estlin Waters. (page 51) Figure 40: Stories of iron tablets being fed to the Rhondda sheep are without foundation, despite this offering from Estlin Waters in the late 1960s. Reproduced by permission of Professor Estlin Waters. (page 54) Figure 41: Serge Renaud’s mobile laboratory at the Caerphilly Miner’s Hospital, 1984–88. Reproduced by permission of Dr Peter Elwood. (page 55) Figure 42: Andrew Beswick doing platelet aggregometry in the Caerphilly study, c. 1989. Reproduced by permission of Dr Peter Elwood. (page 63) Figure 43: Archie Cochrane in retirement with The Times crossword puzzle, c. 1981. Reproduced by permission of Dr Peter Elwood. (page 64) Figure 44: Captain Fred Moore. Drawing reproduced by permission of Dr Peter Elwood. (page 65) Figure 45: Archie Cochrane and Fred Moore at Richmond Road, Cardiff, c. 1981. Photograph reproduced by permission of Dr Peter Elwood. (page 66) Figure 46: Archie Cochrane. Reproduced by permission of the Media Resources Centre, University of Wales College of Medicine and Cardiff and Vale NHS Trust, Cardiff. (page 68) Figure 47: Dust sample taken from a child’s hands for lead pollution studies, 1970s.
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