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Pneumoconiosis in Coalminers

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Pneumoconiosis in Coalminers 6I8 POSTGRADUATE MEDICAL JOURNAL December I949 Postgrad Med J: first published as 10.1136/pgmj.25.290.618 on 1 December 1949. Downloaded from IRVINE, L. G., SIMSON, F. W., and STRACHAN, A. S. (1930), NEW YORK STATE DEPARTMENT OF LABOUR (1949), Proc. Intern. Conf. on Silicosis in Johannesburg, I.L.O. Studies Monthly Review, 28, No. 4, April. and Reports, Series F. (Industrial Hygiene), No. I3, p. 259. PERRY, K. M. A. (1948), Proc. Ninth Intern. Cong. of Ind. Med., JONES, W. R. (I933), ,. of Hyg., 33, 307. London (in the press). KETTLE, E. H. (I932), Y. Path. and Bat., 35, 395. KETTLE, E. H. (I934), Ibid., 38, 20o. POLICARD, A. (1947), Proc. Conf. of the Institution of Mining KING, E. J. (I945), M.R.C. Special Report Series, No. 250, p. 73. Engineers and Institution of Mining and Metalurgy, London, KING, E. J. (I947) Occ. Med., 4, 26. P. 24. KING, E. J., WRI6HT, B. M., and RAY, S. C. (I949), Paper read ROGERS, E. (i944), Paper read to the British Tuberculosis Associa- to the Path. Soc., Great Britain, January, 1949. tion. McLAUGHLIN, A. I. G., ROGERS, E., and DUNHAM, K. C. (I949), Brit. 3Y. Ind. Med., 6, I84. SHAVER, C. G. (1948), Radiology, 50, 760. MINERS' PHTHISIS MEDICAL BUREAU OF SOUTH SHAVER, C. G., and RIDDELL, A. R. (I947), J. Id. Hyg. and AFRICA (1946), Report for the Three Years ending Jy 31, Tox., 29, 145. I944 (South African Government Printer). VORWALD, A. J., and CARR, J. W. (1938), Amer. J7. Path., 14,49. PNEUMOCONIOSIS IN COAL MINERS By J. C. MCVITTIE, M.B., CH.B., D.P.H. Senior Medical Officer, Pneumoconiosis Medical Panel, Swansea In his contribution Dr. Meiklejohn has traced but by workers and their representatives who were historically the recognition of a relationship concerned about the incidence of the disease, and between disease and dusty occupation, and has who were alert to the fact that increasing sickness shown that the ancients were aware of the in- and disability were associated with changing con- dustrial risk and that they, in fact, attributed the ditions underground. In I925 Grenfell presentedProtected by copyright. damage in some degree to the dust they inhaled. the evidence he had collected in South Wales. In Until I83I English medical literature had been one year 22 cases (including 12 deaths) in drillers destitute of a single treatise on diseases of trades and ' hardheaders' had been collected from five and professions. In that year Gregory described collieries. It was emphasized that in one par- the postmortem findings in a case of pneumo- ticular pit the disabled men, whose ages ranged coniosis 'with black infiltration of the whole from 22 to 45 years, worked in the same place or lungs' in a Scottish coal miner. Subsequently heading. Four of the group had died and post- -there appeared a number of references to pul- mortem evidence was available. In the follow- monary disease in coal miners, and valuable and ing year Tattersall reported the tragic story of a critical surveys of the literature appear in an group of rock drillers in another area. As a result excellent paper on ' Coal Miner's Lung' by Lyle of these and other representations a method was Cummins and Sladden, in the first report (medical devised of dealing with the difficulties of the studies) dealing with chronic pulmonary disease situation in this country by a system of ' schemes ' in South Wales coal miners published by the each applicable to a particular industry or group Medical Research Council in 1942, and in the of industries. Thus the Various Industrieshttp://pmj.bmj.com/ scholarly and comprehensive study of the disease (Silicosis) Scheme, 1928, applied to all workmen by Fletcher. Although the reference to coal employed at any time on or after January i, 1929, -miners' pneumoconiosis had priority in our in ' the drilling and blasting in silica rock in or literature, the later studies were concerned incidental to the mining or quarrying of other chiefly with miners' phthisis in metalliferous minerals,' and by it silica rock was defined as mines and with silicosis in other industries, and containing not less than 50 per cent. free silica. -there was considerable delay in bringing workers This scheme identified the disease with particular on October 1, 2021 by guest. in the industries within the scope of the Work-- occupations and with particular working places, men's Compensation Act. In 1907 the Committee and the drillers, brushers and hardheaders were on Compensation for Industrial Diseases recom- required to prove the analysis of rock. There mended that the question of scheduling silicosis was, too, a strange inconsistency between the (fibrosis due to the inhalation of free silica) should above scheme and the Refractories Industries be kept in abeyance for the time being. Later, (Silicosis) Scheme which came into force in I9I9. owing to-successful measures adopted in the gold The latter embraced compensation for partial mining industry in South Africa under successive incapacity as well as death and total incapacity. Miners' Phthisis Acts, pressurE was brought to Certification under the 1928 scheme was by a bear on the Home Office to deal with the subject. certifying surgeon who was not required to make Pressure was brought not only by medical men an X-ray examination. These anomalies were December 1949 McVITTIE: Pneumoconiosis in Coal Miners 619 Postgrad Med J: first published as 10.1136/pgmj.25.290.618 on 1 December 1949. Downloaded from quickly remedied, and since I93I certification of in 1934, Keating reported that he had collected a coal miners under the Silicosis and Pneumo- series of 59 cases (in South Wales) in which the coniosis Schemes has been by medical boards who board had diagnosed the disease and issued the direct an X-ray examination in every case in- appropriate certificates. These cases later came vestigated. This paper is based on the writer's before the Courts which ruled that the claimants experience as a member of the former Medical were not within the scheme, and so their claims Board for Silicosis and later as a member of a for compensation were rejected. The records and Pneumoconiosis Medical Panel of the Ministry of skiagrams in this series were afterwards examined National Insurance in South Wales, and on ex- by Professor Haldane, who accepted as silicosis perience in the South Wales coalfields (193I-33), those where work on hardheadings was recorded in Lancashire, Northumberland, Durham and and classed as pneumoconiosis those without Scotland (I933-43) and again in South Wales record of such work. The most notorious high- (I943-49), and deals mainly with clinical aspects. inicidence mine contained only one seam of silica Within a very short time it was obvious that on rock which at its thickest part was only i in. thick. the medical side silicosis in South Wales miners No drifting or heading work had been done in it presented certain' common features, namely gross for years. There was no mechanical drilling and lesions of the lungs associaed with varying degrees the miners did their own ripping in top and bottom of disability. The cases were unusual in that they shale. The lung disease found in the miners in did not conform to one's experience of the disease this and similar mines was attributed by Haldane as seen in other industries because of (a) the ex- to bronchitis and bronchiectasis, while Jones treme youth of the patient, (b) the comparatively suggested that it was due to inhalation of sericite, short exposure in underground work, (c) the gross a hydrous silicate of aluminium and potassium. nature of the lesion radiographically and the in- On looking at the problem as a whole, it seemed frequency of classical-' snowstorm' opacities in impossible from the medical point of view to draw the lung and (d) the abnormally high incidence in any practical distinction between silicosis andProtected by copyright. certain mines. There were more applications and pneumoconiosis for clinically, radiographically and cases certified in the anthracite valleys, but they pathologically they were identical. were not confined to that area. The writer col- An amending scheme which extended the pro- lected and analysed all the cases seen in I931-32 visions of the 1931 scheme to coal miners em- and found that the age incidence and exposure in ployed in any occupation underground was intro- the attributable risk was the same in the anthracite, duced in 1934. steam and bituminous areas. Silicosis was a In 1935 Thomas, who the previous year had disease of the young driller or ' hardheader ' and briefly referred to a type of case frequently en- of the middle-aged collier. Moreover the disease countered amongst claimants in South Wales, was found in workers not actually engaged in enlarged on the topic from his additional ex- cutting, e.g. hauliers, etc. There appeared to be perience in the interval. Many cases were en- some other factor at work in that, even in high countered in the South Wales coalfield where the incidence mines, certain colliers worked with im- diagnosis was difficult for the following reasons. punity throughout their working lives. Open The industrial history and clinical findings led to tuberculosis was infrequently a complication of the conclusion that a pathological process had de- http://pmj.bmj.com/ the massive type of lesion. The pathological veloped which closely resembled silicotic fibrosis. findings suggested that the. fibroid lesions were Many of the men so affected were totally disabled. comparable, if not indistinguishable, from the in- ,The skiagrams in most instances showed an fective silicosis described by the South African abnormal condition of the lungs which, however, workers.
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