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Chronic pulmonary disease in South Wales coalminers
August 1942
TUBERCLE
April 1941 under the aegis of the Barcelona Academy of Medical Sciences. The subjects discussed fall into two groups according as they deal with fundamental principles and practical applications. The first group conBROMPTON HOSPITAL REPORTS. A sists of papers on the present state of the Collection of Papers recently published bacteriology of tuberculosis, characteristic from the Hospital. Vol. X. 1941. Pp. 127. features of the soil susceptible to tuberculous infection, constitutions and tuberculosis, Price 5S. 7d. post free. predisposition of the organs, the vegetative Of the 10 papers appearing in this volume system and tuberculosis, and immunology only one has not been published elsewhere, and tuberculosis. The papers in the second and this gives an account of the attempt group deal with the mechanism of hygienic made by F. H. Young and E. Gantz to treatment, active and passive immunity, explain why the elimination of lipiodol adjuvant treatment in pulmonary tubercufrom the bronchi is so erratic. Using lung tissue removed at operation from patients in losis, collapse therapy and chemotherapy. whom bronchography had been done they conclude that the duration of retention of CHRONIC PULMONARY DISEASE IN SOUTH WALES COALMINERS. 1.lipiodol depends upon 'the cellular activity Medical Studies. A.-Report by the Comof the phagocytes and on the speed with mittee on Industrial Pulmonary Disease. which fibrous tissue is developing'. As, B.-Medical Survey, by P. D'Arcy Hart however, the material used was the seat of and E. A. Aslett, with contributions by bronchiectasis or neoplasm, further conD. Hicks and R. Yates. C.-Pathological firmation from experiments on normal lung Report by T. H. Belt, with assistance from tissue is needed. This the authors are A. A. Ferris. Medical Research Council, reluctant to do since they are not convinced Pp. xiv-+-222. London: H.M.S.O. 1942. that lipiodol is innocuous in vivo. In a Price lOS. 6d. parallel series of experiments in vitro Drs Young and Gantz have demonstrated some Another of the pneumokonioses has been dissociation of the oil into free fatty acids nailed down; just as thirty years ago the then (but never free iodine) with a rise .in the loosely used word 'silicosis' was defined to acid value and they suggest that this may be the consequences of inhaling fine dust of occur in lung tissue. As a preliminary paper free silica, so now anthracosis is defined as this is valuable and it is hoped that it will due to inhaling dust of anthracite coal. The stimulate further work to explain such investigation now fully reported was organvagaries of lipiodol in the normal bronchial ized by the Medical Research Council, tree as unexpected 'alveolar filling' and when, almost suddenly, on extension to undue persistence in normal lung tissue. coalminers of the provisions of the Art Other articles of current importance repro- granting compensation for silicosis, claims duced in this volume are two of the series from this group of men were found to out'Chest Surgery in War', the first by R. C. number claims from all other industries, the Brock on 'Drainage of the pleura', and the great majority coming from the anthracite second by J. G. Scadding on 'Some aspects mines of South Wales. Indeed, for the period of closed wounds of the chest', and 'The 1931-37,the average annual number of new treatment of traumatic Hemothorax by cases of 'certified silicosis' per 1,000 workers Clifford Hoyle. employed underground was 5'2 in anthracite mines in South Wales, 0'99 in nonPUBLICAClONES DEL INSTITUTO anthracite mines in South Wales, and only ANTITUBERCULOSO. ' F ran cis c 0 0'06 in coalmines in Great Britain excluding Morogas' de la Caja de Pensiones para South Wales. Further, both in Pennsylvania, la Vejez y de Ahorros. Vol. IV. 'Mecan- U.S.A., and in the Donetz Basin, U.S.S.R., ismo de Accion de la Terapeutica investigations have recently been published Antituberculosa'. Barcelona: Institute, in which the dust of anthracite coal is held Antituberculoso 'Francisco Moragas' to be injurious when inhaled over long 1941. Pp. 188. periods. The research has included field This volume consists of a series of 12 post- work in which some 2,000 miners from 16 graduate lectures delivered in March and collieries and nearly 500 coal-trimmers part of India. The illustrations show the building to be of excellent design worthy of the beautiful and central site it has been g-iven in the city.
l88
TUBERCLE
from four coal-exporting ports were examined radiologically and clinically, by lung volume determinations and by tuberculin tests. The whole population of 560 miners were examined at one anthracite colliery where the incidence of compensation cases was especially high. The South Wales coalfield contains all kinds of coal; in the west is anthracite which changes to steam-coal in the centre; and that in its turn shades off into semi-bituminous, and, finally, bituminous in the east. The geography and geology of the field, and the methods by which the coal is got, are described. The pulmonary trouble grades in a similar way from worst in the west to none in the east. The 16 collieries were chosen to represent all parts of the field. Great reliance is placed upon x-ray appearances in the detection of lung changes; first to be seen are reticular shadows, which, as the condition progresses, give way to coalescent shadows representing consolidated fibrosis. Parallel with these x-ray developments, respiratory disability deepens with dyspnoea and cough; but disability is frequently less pronounced than x-ray showings would suggest; it falls mainly on men in the second half of life. The changes are to be distinguished from the arborization going on to nodulation which is characteristic of true silicosis; this condition is seen among a small group of miners who drive hard-headings, i.e. roadways through rocks containing high proportions of free silica, required to reach some distant seam of coal. The usual association of tuberculosis with silicosis is not found with anthracosis; instead of the cases terminating with tuberculosis, cardiac failure and non-tuberculous respiratory affections are more frequent modes of death; certainly, sputum examinations of the anthracotic were negative, and no hyper- or hypo-sensitiveness to tuberculin was found. This does not mean that tuberculosis may not be present with anthracosis; indeed, in 8 out of 42 post-mortem examinations, tuberculosis was definitely found and was suggestive in another 13. The resulting condition is a modification of the two pathological processes, not distinctive of either alone, for which Belt in his admirable report, proposes the name koniophthisis. The precise component or components of the dust which produce these results has not yet been determined; but further light may be thrown upon the matter when the second report, which is to' deal with
August 1942
environmental conditions, is issued in a few weeks. The association of the trouble with dust, and with the dust from anthracite, is indicated by the fact that men working at the coal-face are mainly concerned and in proportion to their years of service underground. But other coal-dust is not entirely exonerated, since coal-trimmers who load ships with steam-coal were found more affected than those loading anthracite; the reason here being that anthracite, as exported, is far less dusty than steam-coal. The outstanding feature is the abnormality termed 'reticulation' which is a characteristic non-nodular pulmonary x-ray change frequently found, and possibly associated with respiratory disability; it may remain without further progression, or it may pass on to the advanced types of consolidation, when more or less disabilitv is usual. This condition is shown well by a series of excellent illustrations. In a lung some areas of dust-reticulation develop silicotic fibrosis, others do not; the progression from one to another is sporadic; hence an unknown sporadic factor is postulated, which alters silica, perhaps by dissolving it, into a substance capable of producing redundant collagenous fibrosis, while unaltered silica remains capable only of producing reticulation. The part played by coal-dust, apart from inorganic particles in the histology of affected lung-tissue is well demonstrated by a number of microphotographs. Not the least remarkable thing about the team work in this inquiry is the way in which the facts ascertained by each group of workers combines and interlocks to present a coherent picture. It is good work. MAN'S GREATEST VICTORY OVER TUBERCULOSIS. By J. Arthur Myers, Ph.D., M.D., F.A.C.P. 1940. Charles C. Thomas: Springfield, Illinois; Baltimore Maryland. London: Bailliere, Tindall &. Cox. Pp, 419. Price £1 7s. 6d.
In the author's preface to this monograph he claims that 'the most audacious undertaking to control tuberculosis among animals and man in the entire history of the wmld began in the United States in 1917, and it has resulted in the only truly successful demonstration of controlling the disease'. The volume is designed to record step by step the methods that have been used to diagnose, treat and prevent tuberculosis in animals, and Dr Myers adds that many
TUBERCLE
April 1941 under the aegis of the Barcelona Academy of Medical Sciences. The subjects discussed fall into two groups according as they deal with fundamental principles and practical applications. The first group conBROMPTON HOSPITAL REPORTS. A sists of papers on the present state of the Collection of Papers recently published bacteriology of tuberculosis, characteristic from the Hospital. Vol. X. 1941. Pp. 127. features of the soil susceptible to tuberculous infection, constitutions and tuberculosis, Price 5S. 7d. post free. predisposition of the organs, the vegetative Of the 10 papers appearing in this volume system and tuberculosis, and immunology only one has not been published elsewhere, and tuberculosis. The papers in the second and this gives an account of the attempt group deal with the mechanism of hygienic made by F. H. Young and E. Gantz to treatment, active and passive immunity, explain why the elimination of lipiodol adjuvant treatment in pulmonary tubercufrom the bronchi is so erratic. Using lung tissue removed at operation from patients in losis, collapse therapy and chemotherapy. whom bronchography had been done they conclude that the duration of retention of CHRONIC PULMONARY DISEASE IN SOUTH WALES COALMINERS. 1.lipiodol depends upon 'the cellular activity Medical Studies. A.-Report by the Comof the phagocytes and on the speed with mittee on Industrial Pulmonary Disease. which fibrous tissue is developing'. As, B.-Medical Survey, by P. D'Arcy Hart however, the material used was the seat of and E. A. Aslett, with contributions by bronchiectasis or neoplasm, further conD. Hicks and R. Yates. C.-Pathological firmation from experiments on normal lung Report by T. H. Belt, with assistance from tissue is needed. This the authors are A. A. Ferris. Medical Research Council, reluctant to do since they are not convinced Pp. xiv-+-222. London: H.M.S.O. 1942. that lipiodol is innocuous in vivo. In a Price lOS. 6d. parallel series of experiments in vitro Drs Young and Gantz have demonstrated some Another of the pneumokonioses has been dissociation of the oil into free fatty acids nailed down; just as thirty years ago the then (but never free iodine) with a rise .in the loosely used word 'silicosis' was defined to acid value and they suggest that this may be the consequences of inhaling fine dust of occur in lung tissue. As a preliminary paper free silica, so now anthracosis is defined as this is valuable and it is hoped that it will due to inhaling dust of anthracite coal. The stimulate further work to explain such investigation now fully reported was organvagaries of lipiodol in the normal bronchial ized by the Medical Research Council, tree as unexpected 'alveolar filling' and when, almost suddenly, on extension to undue persistence in normal lung tissue. coalminers of the provisions of the Art Other articles of current importance repro- granting compensation for silicosis, claims duced in this volume are two of the series from this group of men were found to out'Chest Surgery in War', the first by R. C. number claims from all other industries, the Brock on 'Drainage of the pleura', and the great majority coming from the anthracite second by J. G. Scadding on 'Some aspects mines of South Wales. Indeed, for the period of closed wounds of the chest', and 'The 1931-37,the average annual number of new treatment of traumatic Hemothorax by cases of 'certified silicosis' per 1,000 workers Clifford Hoyle. employed underground was 5'2 in anthracite mines in South Wales, 0'99 in nonPUBLICAClONES DEL INSTITUTO anthracite mines in South Wales, and only ANTITUBERCULOSO. ' F ran cis c 0 0'06 in coalmines in Great Britain excluding Morogas' de la Caja de Pensiones para South Wales. Further, both in Pennsylvania, la Vejez y de Ahorros. Vol. IV. 'Mecan- U.S.A., and in the Donetz Basin, U.S.S.R., ismo de Accion de la Terapeutica investigations have recently been published Antituberculosa'. Barcelona: Institute, in which the dust of anthracite coal is held Antituberculoso 'Francisco Moragas' to be injurious when inhaled over long 1941. Pp. 188. periods. The research has included field This volume consists of a series of 12 post- work in which some 2,000 miners from 16 graduate lectures delivered in March and collieries and nearly 500 coal-trimmers part of India. The illustrations show the building to be of excellent design worthy of the beautiful and central site it has been g-iven in the city.
l88
TUBERCLE
from four coal-exporting ports were examined radiologically and clinically, by lung volume determinations and by tuberculin tests. The whole population of 560 miners were examined at one anthracite colliery where the incidence of compensation cases was especially high. The South Wales coalfield contains all kinds of coal; in the west is anthracite which changes to steam-coal in the centre; and that in its turn shades off into semi-bituminous, and, finally, bituminous in the east. The geography and geology of the field, and the methods by which the coal is got, are described. The pulmonary trouble grades in a similar way from worst in the west to none in the east. The 16 collieries were chosen to represent all parts of the field. Great reliance is placed upon x-ray appearances in the detection of lung changes; first to be seen are reticular shadows, which, as the condition progresses, give way to coalescent shadows representing consolidated fibrosis. Parallel with these x-ray developments, respiratory disability deepens with dyspnoea and cough; but disability is frequently less pronounced than x-ray showings would suggest; it falls mainly on men in the second half of life. The changes are to be distinguished from the arborization going on to nodulation which is characteristic of true silicosis; this condition is seen among a small group of miners who drive hard-headings, i.e. roadways through rocks containing high proportions of free silica, required to reach some distant seam of coal. The usual association of tuberculosis with silicosis is not found with anthracosis; instead of the cases terminating with tuberculosis, cardiac failure and non-tuberculous respiratory affections are more frequent modes of death; certainly, sputum examinations of the anthracotic were negative, and no hyper- or hypo-sensitiveness to tuberculin was found. This does not mean that tuberculosis may not be present with anthracosis; indeed, in 8 out of 42 post-mortem examinations, tuberculosis was definitely found and was suggestive in another 13. The resulting condition is a modification of the two pathological processes, not distinctive of either alone, for which Belt in his admirable report, proposes the name koniophthisis. The precise component or components of the dust which produce these results has not yet been determined; but further light may be thrown upon the matter when the second report, which is to' deal with
August 1942
environmental conditions, is issued in a few weeks. The association of the trouble with dust, and with the dust from anthracite, is indicated by the fact that men working at the coal-face are mainly concerned and in proportion to their years of service underground. But other coal-dust is not entirely exonerated, since coal-trimmers who load ships with steam-coal were found more affected than those loading anthracite; the reason here being that anthracite, as exported, is far less dusty than steam-coal. The outstanding feature is the abnormality termed 'reticulation' which is a characteristic non-nodular pulmonary x-ray change frequently found, and possibly associated with respiratory disability; it may remain without further progression, or it may pass on to the advanced types of consolidation, when more or less disabilitv is usual. This condition is shown well by a series of excellent illustrations. In a lung some areas of dust-reticulation develop silicotic fibrosis, others do not; the progression from one to another is sporadic; hence an unknown sporadic factor is postulated, which alters silica, perhaps by dissolving it, into a substance capable of producing redundant collagenous fibrosis, while unaltered silica remains capable only of producing reticulation. The part played by coal-dust, apart from inorganic particles in the histology of affected lung-tissue is well demonstrated by a number of microphotographs. Not the least remarkable thing about the team work in this inquiry is the way in which the facts ascertained by each group of workers combines and interlocks to present a coherent picture. It is good work. MAN'S GREATEST VICTORY OVER TUBERCULOSIS. By J. Arthur Myers, Ph.D., M.D., F.A.C.P. 1940. Charles C. Thomas: Springfield, Illinois; Baltimore Maryland. London: Bailliere, Tindall &. Cox. Pp, 419. Price £1 7s. 6d.
In the author's preface to this monograph he claims that 'the most audacious undertaking to control tuberculosis among animals and man in the entire history of the wmld began in the United States in 1917, and it has resulted in the only truly successful demonstration of controlling the disease'. The volume is designed to record step by step the methods that have been used to diagnose, treat and prevent tuberculosis in animals, and Dr Myers adds that many