[Mobile miniature X-ray evaluation and pneumoconiosis: the role of the Clinica del Lavoro in Milan (1941-1948)]

Since the end of the 19th century, X-rays have been used to detect lung diseases. In Italy, 207,096 miniature chest radiographs were taken from 1941 to 1948. Traditional radiographs gave better results, but miniature chest radiographs were useful for screening. Indeed, the development of mobile miniature chest radiography units resulted in an improvement in mass X-rays screening for the detection of penumoconiosis. These mobile miniature units were mounted on a bus chassis, a solution that allowed to easily reach workers. The authors analyze some models of X-ray wagon units used by the "Clinica del Lavoro" in Milan in the 1950s. From the point of view of medical museology, the preservation of these devices requires appropriate spaces.

Risk identification and prediction of coal workers' pneumoconiosis in Kailuan Colliery Group in China: a historical cohort study

BACKGROUND

Prior to 1970, coal mining technology and prevention measures in China were poor. Mechanized coal mining equipment and advanced protection measures were continuously installed in the mines after 1970. All these improvements may have resulted in a change in the incidence of coal workers' pneumoconiosis (CWP). Therefore, it is important to identify the characteristics of CWP today and trends for the incidence of CWP in the future.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 17,023 coal workers from the Kailuan Colliery Group were studied. A life-table method was used to calculate the cumulative incidence rate of CWP and predict the number of new CWP patients in the future. The probability of developing CWP was estimated by a multilayer perceptron artificial neural network for each coal worker without CWP. The results showed that the cumulative incidence rates of CWP for tunneling, mining, combining, and helping workers were 31.8%, 27.5%, 24.2%, and 2.6%, respectively, during the same observation period of 40 years. It was estimated that there would be 844 new CWP cases among 16,185 coal workers without CWP within their life expectancy. There would be 273.1, 273.1, 227.6, and 69.9 new CWP patients in the next <10, 10-, 20-, and 30- years respectively in the study cohort within their life expectancy. It was identified that coal workers whose risk probabilities were over 0.2 were at high risk for CWP, and whose risk probabilities were under 0.1 were at low risk.

CONCLUSION/SIGNIFICANCE

The present and future incidence trends of CWP remain high among coal workers. We suggest that coal workers at high risk of CWP undergo a physical examination for pneumoconiosis every year, and the coal workers at low risk of CWP be examined every 5 years.

Osler and the black corpuscles: profiles of three early students of phagocytosis

The discovery of phagocytosis is associated indelibly with Elie Metchnikoff, who coined the term, but more than 30 persons had observed the phenomenon (or inferred its existence) before Metchnikoff came to dominate the field. Two of these early investigators were William Osler and George Miller Sternberg. Osler recognized carbon particles within the phagocytes of patients with miner's lung and carried out experiments in kittens. Sternberg only theorized about phagocytosis but, unlike Osler, bitterly contested Metchnikoff's priority of discovery.

The Osler slide, a demonstration of phagocytosis from 1876

Recently at the Medical Historical Museum of McGill University, Dr. Rick Fraser discovered a microscope slide prepared in 1876 from the lung of a patient with pneumoconiosis. Photomicrographs show the presence of coal dust particles in alveolar cells. This case and several related ones had been reported in 1875 by William Osler, who also had demonstrated the cellular uptake of carbon particles in kittens injected with India ink. In 1869 a Philadelphia physician described the uptake of bacteria by leukocytes in saliva and urine. Both investigators postulated a protective role for this cellular phenomenon. Neither of these reports has been generally cited in histories of immunology. These two papers are summarized here along with a short review of other reports describing phagocytosis which predating Metchnikoff's entrance into the field.

"A mere matter of rock": organized labour, scientific evidence and British government schemes for compensation of silicosis and pneumoconiosis among coalminers, 1926--1940

The growth of statutory compensation for industrial injuries and illness has attracted considerable attention from historians of state welfare and students of organized labour in both Europe and North America. The rights of legal redress for disease and accidents in the workplace have become the subject of some debate among historians of occupational health and safety, most particularly in regard to asbestos-related illnesses. Among the most detailed and scholarly accounts of the subject in Britain are those by Peter Bartrip and his collaborators. In contrast to many accounts in labour and medical history which express strong empathy with the plight of workers who faced injury and death in the workplace, Bartrip adopts a model of industrial behaviour which is closer to rational-choice assumptions of mainstream economics. His recent account of government regulation of occupational diseases since the nineteenth century offers limited comment on the attitudes of trade unionists to accidents, though he broadly maintains that British unions have historically been more concerned with winning compensation awards than pressing for the prevention of hazards in the industrial workplace.

Mineral fiber problems and their management: UK 1890-1935

BACKGROUND

The first intimation that mineral fibers other than asbestos were biologically active, is generally identified with reports of experimental studies by Stanton and Wrench, and Pott and Friedrichs, in the early 1970s. In 1890 however, man-made mineral fiber was recognized to present human health hazards; in 1912 experimental study confirmed asbestos to be fibrogenic, and by 1935 other mineral fibers came to notice as potential lung hazards.

METHODS

Published and archival sources have been reviewed to trace the emergence between 1890 and 1935 of the awareness of the health hazards of various fibrous minerals, and the development of strategies for their control.

RESULTS

By the early 1900s there was evidence that the asbestos substituted for the man-made mineral fiber insulation material employed to improve the thermal efficiency of steam powered engines, presented a serious health problem. In the early 1930s, other mineral fibers came to be suspected of causing pneumoconiosis.

CONCLUSIONS

Containment, local exhaust ventilation and personal respiratory protection were instituted for the amelioration of asbestosis, but because of the limitations of what was perceived to be reasonably practicable on economic grounds, and what was feasible technologically, their benefits were severely limited. Initial and periodic medical examination were introduced as precautionary measures, based on hope rather than on experience. When in the early 1930s, the investigation of coal mine dust and siliceous dust, threw up the hypothesis that fibrous natural mineral dusts other than asbestos might be fibrogenic, this was ignored and no further investigations were pursued and no precautionary measures were set in train.

The Medical Research Council Pneumoconiosis Research Unit, 1945-1985: a short history and tribute

The Pneumoconiosis Research Unit (PRU) was set up to obtain the information needed to eliminate pneumoconiosis of coal workers. To this end, instruments and procedures were developed for dust sampling, delivering dust to animals, testing lung function, reading chest radiographs, conducting respiratory surveys and extracting the relevant information. A provisional estimate of safe working conditions was made using data from four pits. The National Coal Board extended the research to an additional 20 pits, refined the estimate and applied it nationally. Meanwhile at PRU aspects of treatment were explored, immunological techniques were added to the repertoire of skills, other occupational disorders were highlighted and new information obtained on biological variation in lung function and blood pressure. The work laid the foundations for medical epidemiology and evidence-based medicine. Starting in 1959, the Unit took the lead in a world campaign to control lung diseases due to asbestos. This account indicates how these successes were achieved, what were the failures, some tensions which developed and what might have been if some events had been handled differently. If there is a message, it is that for success in research the problem under consideration should be the prime focus of attention and resources.

The South Wales Miners Federation, Miners' Lung and the instrumental use of expertise, 1900-1950

Oral history materials from the South Wales Miners' Library are used to examine the communal understandings of, collective responses to, the scourge of Miners' Lung (pneumoconiosis) in the 1920s and 1930s. Lay epidemiology in mining communities attributed an aetiological role to coaldust at a time when many experts believed miners' pulmonary disease to be bronchitic, or to be silica-induced. In their efforts to secure compensation claims for their members, union officials instrumentally used scientific expertise in a variety of forms: they contributed to epidemiological evidence; they lobbied for more government-funded research; they 'bought' experts; they duped expert witnesses; and they made sophisticated instrumental appeals to the supposed independence of favorable expert judgements. Eventually, miners' situated' 'local knowledge' became scientific orthodoxy, a success story which may be associated with the class-conscious miners' 'bump of irreverence' about expert knowledge, and with the divided character of the expert core-set, sections of which were receptive to miners' 'local knowledge' claims.

Pneumoconiosis: a study of its effect on miners' health in South Wales 1900-1980

Since its discovery in the late 19th century, pneumoconiosis has shaped the lives of thousands of miners. In some ways it became inextricably linked to the South Wales coal field and was a major public health threat to the men who worked in those mines. The disease was caused by the conditions of work and worsened the situation of many who were already living in poverty. This historical research account traces the miners' plight and touches on some of the public health issues raised by the disease.

Chronic pulmonary disease in South Wales coal mines: an eye-witness account of the MRC surveys (1937-1942)

In the mid-1930s reports were accumulating from the British coalfields, particularly from the anthracite area of South Wales, that coal face workers suffered a disabling lung condition that was not recognized as the (compensatable) silicosis of rock workers. The Second World War was threatening and discontent was rife. Government, through the Medical Research Council, initiated a medical and environmental investigation of chronic pulmonary disease in South Wales coalminers to make a systematic survey. The medical surveys, 1936-1942, were undertaken by a member of MRC staff, Dr Philip D'Arcy Hart assisted by Dr Edward Aslett of the Welsh National Memorial Association. One colliery (Ammanford) was intensively investigated; fifteen others less so; coal trimmers at the docks were added. The main observations were to confirm and describe radiographically the frequency of serious lung lesions apparently due to coal dust, and distinguishable from classical silicosis. Among recommendations accepted by Government, the lung condition became recognized for compensations, and the generic term pneumoconiosis of Coal Workers' was substituted for silicosis.

A battle for compensation for Welsh coal miners: JS Haldane v "Sericite" Jones, 1932-1934

Toward the end of the 1920s, technical advances in mining led to an increase in airborne burdens of dust in the South Wales coal mines. This coincided with a dramatic increase in the incidence of disability and death from respiratory disease among the miners. For their condition to be compensable, claimants were required to have worked with rock containing more than 50% 'free silica.' Dr W.R. Jones, a mining geologist, was asked to help obtain compensation for those claimants who could not satisfy the 'free silica' condition. He was unable to identify high-silica rocks where none had been said to exist. He did however, successfully argue the brief against the eminent Professor J.S. Haldane (who was the dominant authority, having had lengthy experience in the field of health and mining), for the fibrous form of sericite being commonly the important agent responsible for pneumoconiosis. As a consequence, the category of miner eligible for compensation was broadened. Evidence was gathered worldwide that supported the hypothesis that silicates and not just crystalline silica could cause pneumoconiosis. Despite the suspicions raised about the special power of mineral fibers during this public debate, some 40 years were to elapse before potential health hazards from fibers other than asbestos were to be taken seriously and investigated.

From explosions to black lung: a history of efforts to control coal mine dust

Highlights in the history of efforts to prevent occupational lung disease among coal miners in the United States are reviewed. The Federal Coal Mine Health and Safety Act of 1969 is summarized, and the sources and effects of its provisions to prevent coal workers' pneumoconiosis are examined. Descriptions follow of the identification of coal workers' pneumoconiosis as a disease, identification of respirable coal mine dust as its cause, and establishment and enforcement of an exposure limit. The development of prevention efforts focusing on surveillance of both exposure and outcome and of enforcement of dust control methods is examined.

Victoria M. Trasko: champion of state-based surveillance of occupational diseases in the United States, 1937 to 1971

Victoria M. Trasko (1907-1979), a relatively unknown figure to many currently practicing occupational health specialists, was a pioneer in state-based surveillance of occupational diseases in the United States. To highlight her accomplishments during her career with the United States Public Health Service from 1937 to 1971, this report briefly reviews her publications on occupational disease surveillance. Her span of work includes guidelines for state industrial hygiene programs, numbers of workers in state occupational health programs, compilation of state and local laws related to industrial hygiene, proposals for standardized reporting of occupational disease, and analysis of trends in workers' compensation and mortality statistics for occupational diseases. She pilot tested the first state-based model system for occupational disease reporting in the United States. She documented the great difficulty experienced by states in getting physicians to report cases of occupational diseases, and pointed out that surveillance of other existing data sources was worthwhile, at least for some occupational diseases. She was the first to report on the distribution of silicosis cases in the United States by state, industry, and job title. She was the first to comment on mortality trends for the pneumoconioses and to document problems in comparability between different International Classification of Disease (ICD) periods.

Coal workers' pneumoconiosis: a historical perspective on its pathogenesis

The earliest observations on coal workers' pneumoconiosis identified fundamental factors and posed particular problems in its genesis. Among the former, intensity of exposure and particle size were recognized, while argument commenced on the roles of stone dust, thus anticipating the quartz question, and of complicating pulmonary states, which introduced the idea of infection. Major studies of the disease were precipitated by its greatly increased prevalence, which became evident among South Wales coal workers from the 1930s. The principal directions of enquiry remained the same as in Scotland a century before, namely the components of coal mine dust responsible for fibrosis and the additional factor required for the development of massive fibrosis. The combined human and experimental evidence now makes possible conclusions in which confidence may be placed.

Western miners and silicosis: "The scourge of the underground toiler," 1890-1943

This paper examines the history of silicosis in the mines of the western United States between 1890 and 1943. After establishing the seriousness of the health threat posed by the disease, the author describes the methods of prevention known to be effective during that period, the slow pace at which mine operators adopted those methods, and their campaign to defeat silicosis-compensation legislation in one western state, Arizona. Also described is the surprisingly passive role played in this controversy by the Western Federation of Miners. Finally, the author finds some empirical evidence of the Kerr-Siegel hypothesis, namely, silicosis may have been a “mass grievance” that helps to explain the violent labor history of the mining West.

Black lung: the social production of disease

The black lung movement that erupted in West Virginia in 1968 was not simply a struggle for recognition of an occupational disease; it grew into a bitter controversy over who would control the definition of that disease. This article examines the historical background and medical politics of that controversy, arguing that black lung was socially produced and defined on several different levels. As a medical construct, the changing definitions of this disease can be traced to major shifts in the political economy of the coal industry. As an occupational disease, the history of black lung is internally related to the history of the workplace in which it is produced. As the object of a mass movement, black lung acquired a political definition that grew out of the collective experience of miners and their families. The definition of disease with which black lung activists challenged the medical establishment has historical roots and justification; their experience suggests that other health advocates may need to redefine the diseases they hope to eradicate.

Richard Quiller Couch--an outstanding nineteenth century general practitioner

The boom in metal mining in the mid-nineteenth century produced a fearful mortality among miners. The history of this problem is described by the life and work of Mr R. Quiller Couch, a Cornish mine surgeon and general practitioner. He was a remarkable man and an outstanding general practitioner.

Pneumoconiosis in Chilean miners of the 16th century

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Letter: Sand pneumoconiosis in an egyptian mummy

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The Australian contribution to the history of the pneumoconioses

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