68 research outputs found

    The white death: silicosis (miner's phthisis) on the Witwatersrand gold mines 1886-1910

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    A THESIS SUBMITTED TO THE FACULTY OF ARTS, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY.In its chronic form silicosis had always been been taken for granted as one of the occupational hazards of mining. But both during and shortly after the Anglo-Boer War it manifested itself in a new accelerated form amongst former Witwatersrand rock drillers. Despite the appointment in the Transvaal of a commission of enquiry in 1902 and the promulgation of dust precaution measures, by 1912 the prevalence of and mortality from the disease amongst the Witwatersrand miners had not diminished. This finding suggests two of the purposes of the study: first, the reasons for the continued prevalence of the disease; and second, the extent of the mortality from silicosis amongst the miners. Because of the apparently low prevalence of and mortality from the disease amongst African mineworkers, the disease was ironically nick-named the "white death". Therefore another aim of the study is to examine the validity of the medical claim that the short contracts of African migrant workers safeguarded them from contracting accelerated si licosis. As the subject is complex, the study uses a thematic approach. Chapters two to nine deal with significant themes: first, the growing medical knowledge concerning silicosis, the mining and medical precautions against the disease and the age-old disregard for the occupational illness in its chronic form; second, the industrialists* need to reduce working costs, the development of mass-production technologies and the resort by management to "speeding up"; and third, the miners' needs for job and wage security, the encroachment of African competitors in semi-skilled and skilled spheres of mining and the introduction and the extension of the colour bar. Chapter nine deals with underground health conditions. Chapter ten explores the awareness of the new form of the disease, accelerated silicosis, and the establishment in 1902 of the first Transvaal commission on silicosis. Chapter eleven discusses the failure to implement remedies. Finally, chapter twelve explores the prevalence of and mortality from silicosis and the impact of the disease on the workforce of the mines. In chapters ten, eleven and twelve a synthesis is offered of the themes and findings of the previous chapters. The project is based almost entirely on contemporary primary and published sources. Apart from silicosis, a unifying theme throughout the discrete sections is the perceptions of miners of their vocation in general, and of this occupational disease in particular. The study requires periodization. As silicosis is a slow-developing disease the starting point of the investigation is 1886, when gold was discovered on the Rand. The study ends in 1910 because the establishment of Union in 1910 and the legal award of compensation in 1911 heralded a new era in the history of silicosis on the South African gold mines. The following are the conclusions. First, almost an entire generation of overseas miners, most of whom remained migrants and whose skills pioneered the South African gold mining industry, died from silicosis. Second, for reasons of self-interest, some of which they shared with one another, both the Transvaal state and the Randlords did virtually nothing to remedy the occurrence of the disease. Both parties were culpable for the neglect of the health of the industry's workforce: using only perfunctory dust safeguards, management intensified production through the deployment of both modern technology and labour intensive practices, peculiar to the Witwatersrand; and most of the state's interventionist initiatives were the result of pressure from the British House of Commons. Third, the fear and anger of miners at being the victims of a preventable occupational disease, provided the catalyst for their militancy during the period. Fourth, the industry's power was partly responsible for causing both the press and medical profession to be silent about the problem until 1910. Finally, the mineowners both seized and promoted the unsubstantiated medical orthodoxy, namely that the short contracts of African mineworkers protected them from accelerated silicosis, as an important rationale for perpetuating the migrant labour systemAndrew Chakane 201

    Bronchiectasis

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    On pulmonary phthisis

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    Pneumoconiosis in the South Wales anthracite coalfield

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    1. Some other factor co-exists with the silica dust in the production of pneumoconiosis in the Anthracite Coalfield, which the writer prefers to call "the infective factor". 2. Pneumoconiosis is a progressive disease, taking many years, according to the intensity of the exposure, to produce the fibrosis characteristic of the condition. 3. The incidence of the condition increases with the carbon content of the coal. This is most marked in three peak areas of the Anthracite Coalfield, namely, at (1) Ystalyfera, (2) Gwauncaegurwen and (3 ) Ammanford. 4. The Collieries in these areas are warm, dry, and dusty. 5. All classes of underground workmen are liable to develop pneumoconiosis, and this is so whether or not they are actually engaged in boring or handling the rocks. 6. The Registrar General's statistics of the death rate in industrial areas are built solely upon the death certificates issued by the doctor. Such statistics when they refer to the term 'Bronchitis' are often erroneous and misleading in that they do not disclose a true statement as to the cause of death. 7. The first complaint of 80% of the miners suffer in g from pneumononiosis is 'shortness of breath'. 8. It is remarkable how patients can still do an arduous day's work with extensive fibrosis of both lungs. 9.Difficulty is often experienced in finding tubercle bacilli in the sputum, or any evidence of tuberculosis on post mortem examination, even when the clinical features and physical signs are those of fibrosis with tuberculosis. 10. A miner suffering from pneumoconiosis with superadded tuberculosis seems very resistant to the disease. He may linger on for years. But the children of the infected person, if they develop tuberculosis, contract it in a very acute form. 11. Unfortunately, the physical signs in pneumoconiosis are few and rather vague. The characteristic sign on which the writer relies is the prolonged expiration with the almost pathognomonic harshness which one hears at the end of the inspiratory phase. 12. A properly conducted X -Ray examination is, as yet, the most satisfactory and the most accurate means of studying the effect of the inhalation of dust. 13. During the pre-silicotic stage the workman is able to carry out his full days work without complaint. 14. During the first stage silicosis the miner is only able to do light work in the open air. 15. In the 2nd, 3rd, and the stage of silicosis with super-added tuberculosis, the workman is totally incapacitated from following any occupation. 16. There is urgent need for investigation into the preventive measures to be taken to counteract this scourge of the anthracite miners. The prophylactic measures now taken are totally inadequate and only provide for one class of workman. 17. Periodic clinical and X -Ray examinations should be carried out at the Collieries. These should include an examination prior to employment and then at annual intervals. The disease could be detected at an early stage and the workman immediately withdrawn from his underground employment on the first appearance of the signs. 18. The existing compensation procedure is too complicated and too bound up in 'red -tape'. There should be no intervening step between the man's own doctor and the Medical Board. The Regional Medical Officer's examination and certificate could easily be obviated. 19. The present Board with its headquarters at Bristol serves the South West of England and all Wales. This is too large and scattered an area.. A separate Medical Board should be set up at Swansea as the most suitable centre to serve the Anthracite area. 20. Legislation should be introduced to modify the present Silicosis-Asbestosis Compensation Act so that it might include all classes of underground workmen. 21. (a) The number of patients examined and skiagrams taken of their chests: 30. (b) The average age of patients examined: 49.9 years (c) The number of patients with sputa. positive to the tubercle bacillus: 3 = 10% (d) The number of children of patients. examined who have died from pulmonary tuberculosis: 3 = 10% (e) The number of children of patients examined who are at present suffering from pulmonary tuberculosis: 5 = 16.66% (f) The number of patients with a negative sputum but with skiagrams suggestive of super-added Tuberculosis: 17 = 56..66

    Silicosis and Tuberculosis in Sheffield Metal-Grinders: A Clinical-Statistical Study

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    Diseases of the lungs due to the inhalation of dust and characterised by cough, increasing breathlessness and wasting or phthisis have been recorded since the 5th century B.C. At first many kinds of dust were believed to be equally injurious in their effects on the lungs, but in the light of present knowledge, the sole offending agent is recognised to be free crystalline silica in a finely divided state. This when inhaled into the lungs gives rise to fibrosis (silicosis), the degree of which varies with the intensity and duration of exposure to the dust. Furthermore, this type of fibrosis seems peculiarly liable to complication by pulmonary tuberculosis. The mode of action of the silica is not wholly understood, but at present the majority of workers in this field adhere to the hypothesis of Gye and Kettle, who assert that the silica forms a sol which acts as a direct cell poison. Thereby an area of coagulation necrosis results, in which the tubercle bacilli are protected from phagocytosis aid so can multiply rapidly with impunity. That tuberculosis complicating silicosis is of an unusually rapid and fatal type is the recorded opinion of a great many writers on the subject. Metal grinders in the Sheffield cutlery industry suffer from silicosis, the silica being derived from the sandstone or gritstone wheels on which they work. Tuberculosis also is exceedingly common among them. With a view to throwing some light on the problem of silicosis and tubercularisilicosis, these conditions have been investigated among the Sheffield metal-grinders. Data have been assembled concerning 310 fatal cases of tuberculosis in metal grinders, and, as controls, 1,361 fatal cases among males engaged in other occupations in Sheffield. A further series of living cases - 71 grinders and 409 controls - have also been analysed. The following aspects of the Silica Dust problem have been examined and analysed: a. Mortality rate of pulmonary tuberculosis among metal-grinders at the present day. b. Review of mortality rate of pulmonary tuberculosis among metalgrinders for the last 40 years (1886 - 1925). c. Mean age at death. d. Average Fatality period. e. Average Morbidity period. In Table 15 is set forth a summary of the main facts established

    A treatise on pulmonary tuberculosis: in its pathological, clinical, and sociological aspects

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    In the following pages, I have attempted the presentation of pulmonary tuberculosis, in its pathological, clinical, and sociological aspects. Such a work is naturally largely influenced by the teaching of undergraduate days, particularly by that of Professor Wyllie, Professor Hamilton, Dr Philip and Dr Gm A. Gibson, whose teaching I have followed and in places reproduced. Such a treatise must also be reflective of the literature perused, and. as the author has been mostly in contact with French writings, it has the interest of showing the opinions of the modern French School. There is also given the results of two pieces of clinical research; on the action of Tuberculin T.R.in'phthisis, and on the trial of sulphur as a curative agent

    Certain relationships between pleurisy and tuberculosis

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    Tubercular bronchial glands: their diagnosis and treatment in relation to pulmonary tuberculosis

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    Many cases present themselves at hospital showing signs of early pulmonary tuberculosis, which upon investigation appear to be the result of pressure on the lungs by enlarged bronchial glands. Some years ago, Percy Kidd drew attention to this occurrence but did not suggest any specific treatment. In view of the fact that hospitals for tuberculosis refuse so far as possible - all cases so far advanced that there is little hope of permanent arrest, it is most important to discriminate between early and advanced stages of the disease. It is the object of this thesis to discuss certain cases which at first sight appear far more advanced than is really the case, but in which the symptoms are misleading and apparently inconsistent, and to submit the theory that certain patients who appear to show signs of established pulmonary tuberculosis and who would be classed as fairly advanced cases, may in reality be suffering from enlarged bronchial glands, yielding very satisfactorily to treatment. This is based on a number of cases in the Brompton Hospital for Consumption and Diseases of the Chest and at a Tuberculosis Dispensary, of which six hospital cases have been appended in illustration. It will be noted that the patients are all children or young persons and this point is important - (1) because tuberculosis in children has a much greater tendency to become widespread than in adults; (2) because there is far greater hope of complete arrest while the trouble is still confined to the lymphatic system; (3) because if there be any truth in Dr. Batty Shawls contention that development of tuberculosis in later life is more often due to auto-infection than to re-infection from outside sources, it is the more important to arrest the disease in its earliest manifestations

    The treatment of tuberculosis in Ireland from the 1890s to the 1970s a case study of medical care in Leinster

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    In the late nineteenth century tuberculosis was endemic in Ireland being responsible for more deaths than any other single cause. There was no medical cure for the disease, although various treatment regimes were tried, some with modest success. In the decade to 1891, 103,314 deaths were attributed to the disease, a ratio of one in every 8.5 deaths. By the late 1960s the contribution of tuberculosis to mortality statistics was insignificant. In 1970, 221 persons died from tuberculosis in the Republic of Ireland, a ratio of one in every 152.4 deaths. In terms of medical disease statistics, this fall in mortality was spectacular. This thesis sets out to explore what was behind this dramatic change. It will do so by examining in detail the key international and national developments pertaining to the treatment of tuberculosis. How did the international understanding of tuberculosis evolve and how did this in turn influence the development of facilities to manage the disease? What models of treatment were followed in Ireland and did they contribute to effecting the change? In what way did the political system retard or accelerate the process of change
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