Georgius Agricola: 1494 1555 - Mining Engineer Conclusion and Physician the Lack of Agreement Between Participating Microscopists Is of Considerable Concern

ARTICLES

participating laboratories, beyond chance. The uniformly low HISTORY OF MEDICINE agreement found for all possible pairs of laboratories further exemplifies the lack of diagnostic concordance between them. Georgius Agricola: 1494 1555 - mining engineer Conclusion and physician The lack of agreement between participating microscopists is of considerable concern. Future reliance on thick smear His contribution to occupational medicine diagnosis of malaria in Mpumalanga can only be justified if a and the aetiology of bronchus carcinoma uniform training and quality assurance programme is established. An appreciation of the significance of the study SA Craven findings contributed to the decision to introduce an immunochromatographic test for rapid field diagnosis of Georgius Agricola is well known in mining circles because of malaria.6 his textbook of mining, De Re MetaJlica, which was These findings should also serve to warn against published posthumously in 1556. For the next 180 years, it diagnostic complacency and should prompt similar was the only guide available to miners and metallurgists, investigation of other public health programmes. and was widely read. It has since become a very scarce collector's item, but the 1950 reprint of the 1912 English REFERENCES translation by a future president of the USA and his wife is 1. Landis JR. Koch GG. A one-....ay components of variance model for categorical more readily available.' data. Biometrics 1977; 33: 671-679. 2. Fleiss JL. Cuzick J. The reliability of dichotomous judgments: Unequal numbers Agricola was also a physician, having trained in Italy. In of judges per subject. Applied Psychological Measurement 1979; 3: 537-542. 3 Sackett DL. Haynes RB, Guyatt GH. Tug....ell P. Clinical Epidemiology - A Basic 1527 he was appointed town physician at Joachimstal (now Science for Clinical Medicine. 2nd ed. Boston: Little. Brown. 1991: 31-47. Jachymov) on the Czech side of the metalliferous Erzgeberg 4. Dowling MAC, Shute GT. A comparative study of thick and thin blood films in the diagnosis of scanty malaria parasitemia Bull World Health Organ 1966; 34: 249 Mountains. In about 1533 he became town physician at 267. Chemnitz. on the German side of the mountains. 5. Landjs JR. Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174. Agricola can therefore be expected to have attended the 6. Garcia M. Kirimoama S, Mar1bofough D, et al. Immunochromatographic test for malaria diagnosis. Lancet 1996; 347: 1549. Erzgeberg miners, and his book indicates that he was familiar with the occupational diseases and hazards of Accepted 28 Nov 1996. mining. He described the effects of foul air, cold and wet conditions, heavy-metal poisoning and accidents. He also recorded the respiratory diseases of miners, and attributed them to dust. It is worth quoting him verbatim: .. penetrates into the windpipe and lungs, and produces diffiCUlty in breathing, and the disease which the Greeks call asthma.' '... it eats away the lungs, and plants consumption in the body.' The former description is compatible with silicosis and pneumoconiosis, the latter with tuberculosis - both traditional diseases of miners. The latter description suggests that Agricola examined the lungs post mortem. Neither description is compatible with bronchus carcinoma, which is usually a macroscopically localised disease that does not 'eat away the lungs'. The Erzgeberg mines contain radioactive pitchblende, in which radium was first described by Marie Curie.2.3 Radium decays through, inter alia, radon to stable lead.~ Radon and its daughters, being gaseous, readily enter the lungs and are not cleared by the cilia. They therefore irradiate the bronchi, bronchioles and alveoli. The Erzgeberg miners formed the population in whom bronchus carcinoma was first described in 1879, and in whom a 20 - 50-year exposure to mine conditions was required for the carcinoma to develop. The authors of this detailed investigation into the 'bergkrankheit' were aware that it had previously been misdiagnosed as pulmonary

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SA Craven. MA. BM. BCh. PhD. LRCP. MRCS

SAMJ Volume 87 Nu.5 May 1997 ----~ ---~----

ABC of Urology tuberculosis_ They therefore made enquiries at the distant mining communities of Modum (Sweden) and Dobschau Edited by Chris Dawson and (Hungary), and ascertained that no bronchus carcinoma Hugh Whitfield occurred there. ~ If it were assumed that the miners commenced their hazardous occupation while still in their teens, they could be expected to have developed their Paperback: 297 x 212 mm, 60 pp carcinomas by the age of 35 years or shortly thereafter. January 1997 Agricola made no distinction between the occupational R160 including VAT (MASA Members R152) diseases of the Erzgeberg miners and those of miners elsewhere. It is therefore questionable whether at that tobacco-free time the incidence of bronchus carcinoma in European miners differed from that in non-miners. It must have been a very rare disease then. Tobacco was introduced into Europe in 1556,& too late to have confounded Agricola's observations on miners' respiratory illnesses. A recent review of the history of the radon problem in mines makes no mention of the probable contribution of tobacco smoke to the aetiology of bronchus carcinoma in radioactive mine workers.' The failure of Agricola to report any respiratory disease peculiar to the Erzgeberg miners that was compatible with bronchus carcinoma suggests that radon per se is not carcinogenic for bronchi. It is probably the synergistic effect of tobacco smoke that is responsible for radioactive miners' bronchus carcinoma. An alternative explanation may be that the 16th century Erzgeberg miners did not live long enough to develop bronchus carcinoma. In the northern Pennines of England, where the mines are not radioactive, the average age at death of lead miners in the years 1837 - 1841 was 47.6 years.&A century later in the USA, a series of 31 uranium Urological problems comprise a wide range of miners wrth bronchus carcinoma presented at an average conditions, most distressing and some life age of 54 years (range 42 - 72).' The lack of statistics for the threatening. With the increasing average age of 16th century, and for the Erzgeberg miners, will ensure that the population, the number of presentations in this possible explanation will remain unproven. general practice is growing rapidly. The ABC of Urology provides an authoritative, concise, and comprehensive guide to the specially. Recommendations Concentrating on diagnosis and treatment of the most common conditions, the emphasis is on the Tobacco smokers should not be employed in radioactive new approach to shared care, using the skills of mines. Caves, especially poorly ventilated ones, are known the primary care team in conjunction with to contain not insignificant quantities of radon. 10 Smokers hospital referral. should therefore also not be employed as show cave guides. Chapters include: • Patient evaluation' bladder I am grateful to Professor Arrigo A Cigna of Cocconato, Italy, outflow obstruction' urological emergencies in for a photocopy of the Harting and Hesse papers, and to Or Ulla general practice' sUbferlilily and impotence von der Heyden of Cape Town for her helpful comments thereon. • urinary incontinence and infection' carcinoma REFERENCES of the prostate' bladder cancer' renal and

1. Hoover HC, Hoover LH. Georg,us Agncola De Re MetafJlal translated from the testis cancer' stones' common paediatric first Latin edirioll of 1556. New YOl'k: Dover. t912; repnnted 1950. 2. Curie S. Rayons emlS par Ies composes de I'uranium et du monum. Comptes problems' urological trauma and bladder rendus des 5eam::es de I'Academie des Sciences 1898; 125(15): 1tOl-' 103. 3. Curie P, Bemont G. Sur une l"IOI1Velle substance fonement radio-active. c:onlel'1ue reconstruction. dam la pec:heb!ende. Comptes randus des seances de I'Academ{e des Sciences 1898; 127(26): 1215--1217. 4. Man.: HF, Otllmer VF. Ovetbetget CG. eds. Kirlc-othmer Encyclopaedia of The highly illustrated, practical text will prove Chemk;aJ Technology. Jrd 8<:1. Vol 19. New YorK: John Wiley. 1982: 653-655_ 5. Hirung FH, Hesse W. Oer Lungenkrebs. die BCf"gkrankhelt in den Schneebe.-ger invaluable to general practitioners and practice Gruben. Vlefterljahresschnfl fUr gerichrl. Medizin unr off. Sanitatswesen, N. Fo/ge nurses, as well as being a useful reference for 1879; JO; 296-309; 31: 102-132, 3t3-337. 6. Encyclopaedia Brirannicii. Vol 22. ChIcago: 1968: 43. junior doctors managing patients referred to 7. Jacobi W. The Hisrory of rile Radon Problem in Mines and Homes (ICRP Publication 65). Pergamon: IRCP, 1993: 39-45. hospitals. 8. Raistrick A. Jennings B. A History of Lead Mining in the Pennines. London· Longman, Green & Co. 1965: 304. 9. Wagonef" JK, Archer YE. Lundin Fe, Holaday OA. Uoyd JW. Radiation as the cause of lung cancel'" among uranium miner.;. N Engl J Med 1965; 273 (4): 181-188. 10. Ford TO, ed. Symposium on radon In caves. Trans Br Cave Research Assoc 1991; Order your copy from MASA Multimedia, 18 (2): 63-90. Private Bag X1, Pinelands 7430 or Accepted 30 July 1996. telephone Edward MacDonald at (021) 531-3081, fax (021) 531-4126. Cheques, Visa and Mastercard accepted. Volume 87 No.5 May 1997 SA.~1J