404 BRITISH MEDICAI JOURNAL 9 MARCH 1974 Lightdale, C. J., Kurtz, R. C., Boyle, C. C., Sherlock, P., and Winawer, S. J., Journal of the American Medical Association, 1973, 226, 139. according to a court ruling, need not necessarily entail dis- 2 Dunphy, J. E., Mikkelsen, W. P., Moody, F. G., and Silen, W., Archives ability, and the report recommends that a diagnosis ofpneumo- of Surgery, 1973, 107, 367. Schiller, K. F. R., Truelove, S. C., and Gwyn Williams, D., British coniosis should not in itself entitle to benefit. This means that Br Med J: first published as 10.1136/bmj.1.5905.404 on 9 March 1974. Downloaded from Medical journal, 1973, 2, 7. it will be necessary in cases where a radiological diagnosis of 4Boulos, P. B., Harris, J., Wyllie, J. H., and Clark, C. G., BritishJournal of Surgery, 1971, 58, 817. pneumoconiosis has been made to show functional impairment 6 Wilson, W. S., Gadacz, T., Olcoff, C., and Blaisdell, F. W., American before the patient becomes of Surgery, 1973, 126, 133. eligible for benefit. 6 Drapanas,6Journal T., Woolverton, W. C., Reeder, J. W., Reed, R. I., and Wei- Though the number of newly diagnosed cases of coal chert, R. F., Annals of Surgery, 1971, 173, 628. Taylor, P. C., Loop, F. D., and Hermann, R. E., Annals of Surgery, 1973, workers' pneumoconiosis has fallen considerably, the increase 178, 1. in new cases of asbestosis and of diffuse mesothelioma has 8 Skillman, J. J., and Silen, W., Lancet, 1972, 2, 1303. 9 Palmer, E. D., J'ournal of the American Medical Association, 1969, 207, meant a continuing high work-load for the medical panels. 1477. Responsibility for examinations relating to poisoning by 10 Morrissey, J. F., Gastroenterology, 1972, 62, 1241. "George, P., Brown, C., Ridgway, G., Crofts, B., and Sherlock, S., British nitrous fumes, beryllium, or cadmium and to lung cancer in 3Journal of Surgery, 1973, 60, 635. nickel workers should be transferred to 12 Pugh, R. N. H., Murray-Lyon, I. M., Dawson, J. C., Pietroni, M. C., and these panels, says the Williams, R., British Journal of Surgery, 1973, 60, 646. report, while the problem of the extension of cover to grade 2 ' Hunt, P. S., Johnstone, G. W., and Rodgers, H. W., British J7ournal of Surgery, 1969, 56, 305. byssinosis (chest tightness on a number of days in the working week but without evidence of permanent incapacity) has been referred for further investigation. No change has been recom- mended in the requirement that a claimant for benefit must have been employed for a minimum period of ten years in Compensation for processes involving exposure to raw cotton or to flax dust. Pneumoconiosis and The controversies aroused by these issues in many quarters have been exemplified by the Advisory Council itself, for four Byssinosis of its 18 members dissented from the views expressed in the report on the important question of whether the presence of Over the years a cumbersome edifice has been built of statu- pneumoconiosis should itself be an entitlement to disability, tory provisions relating to the assessment of disablement from the exclusion of bronchitis and emphysema from prescription, occupational lung diseases. Prominent in this legal labyrinth and on the ten year qualifying period for byssinosis. Very soon is the definition given to pneumoconiosis as: "fibrosis of the after publication of the report, however, the Government lungs due to silica dust, asbestos dust or other, dust, and announced its intention of continuing with the present includes the condition of the lungs known as dust reticula- arrangements for compensation for pneumoconiosis. tion." Greater understanding of the pneumoconioses has In the preparation of its report the Industrial Injuries revealed inevitable inadequacies in existing definitions and Advisory Council considered the prevention of the pneumo- practice, so that in 1968 the Minister of Social Security asked conioses outside its terms of reference. Fortunately the report the Industrial Injuries Advisory Council to consider whether does show that pneumoconiosis medical panels are concerned any change should be made in the definition of pneumo- with preventive aspects by pointing to the importance of the coniosis and whether in assessing disablement provision should continuing surveillance of workers in occupations with a high http://www.bmj.com/ be made for other respiratory conditions found in the presence risk ofdeveloping pneumoconiosis. Again, the report correctly of pneumoconiosis. emphasizes the extra risk to asbestos workers who smoke The Industrial Injuries Advisory Council has now issued a cigarettes-but do medical panels point out this risk to the report' on pneumoconiosis and byssinosis which attempts to men they are called upon to assess ? rationalize some of the present inconsistencies. The council The medical panels will need to be closely identified with has concluded that a legal definition for pneumoconiosis will the mainstream of chest medicine and become closely con- is a term; still be necessary. Fibrosis, however, pathological cerned with research if they are not to become isolated-for on 28 September 2021 by guest. Protected copyright. the condition cannot be diagnosed with certainty on radio- they will remain outside the reorganized N.H.S. and the- logical or clinical findings alone, and, furthermore, some Employment Medical Advisory Service. The persistence of tissue changes induced by inhaled dust may not be collagenous the pneumoconioses and allied disorders represents an at all. Dust reticulation has for long been a confusing term and important public health failure of the past, and the efforts of is wisely being dropped. No definition of dust has been all doctors in this field including those on the pneumoconiosis offered, but it was considered necessary to exclude vegetable medical panels should be closely integrated ifwe are to remedy dusts. The definition proposed for pneumoconiosis has, there- this failure in the future. fore, become: "permanent alteration of lung structure due to the inhalation of mineral dust and the tissue reactions of the National Insurance (Industrial Injuries) Act. London, H.M.S.O., 1965. lung to its presence but does not include bronchitis and Pneumoconiosis and Byssinosis. London, H.M.S.O.. 1973. emphysema." The report qualifies this very important exclusion by adding that account should be taken of these conditions under the rules for the assessment of disablement. The exclusion of bronchitis and emphysema was considered or necessary because of the difficulty in attributing individual Insurance Gamble? cases to the nature of the employment. Pleural abnormalities (such as diffuse thickening, plaques, Full-page advertisements for schemes providing a cash and calcification) which can be ascribed to exposure to benefit for each night spent in hospital have been appearing in asbestos dust would be included within the definition of the national press for nearly three years. Apart from the news- pneumoconiosis, which would no longer require evidence of papers that accepted them, have these advertisements benefited parenchymal fibrosis. Furthermore, the report recommends anyone ? Most of the schemes are sponsored by American, or that all claims for benefit for diffuse mesothelioma should be American-owned, companies; one is underwritten at Lloyds. dealt with in the same way as pneumoconiosis. Abnormality, They are profit-making and in this respect can be distinguished