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P U U ~ M ~~B~oP,,

PrepybI) distrfbufioa by -upon only -- see other side for ordering information.
 Henry N. Doyle*

One c a n - h a r d l y d i s c u s s c o a l pneumoconiosis u n l e s s i t i s p l a c e d i n

t h e c o n t e x t o f t h e t o t a l pneumoconiosis problem i n t h e mining i n d u s t r y .

However, i t might be w e l l i f f i r s t w e d e f i n e d a few t e r m s , s i n c e i t has been

my e x p e r i e n c e t h a t t h e u s e o f t h e word pneumoconiosis f r e q u e n t l y c a u s e s con-

f u s i o n among t h o s e who a r e n o t f a m i l i a r w i t h t h e t e r m . Pneumoconiosis comes

from two Greek words meaning l u n g and d u s t . Hence, t h e word pneumoconiosis

simply means d u s t y l u n g , o r d u s t on t h e lung. There are many forms o f t h e

d i s e a s e , some o f which a r e d i s a b l i n g and some a r e n o t . Among t h e many d u s t s

which c a u s e pneumoconiosis might be i n c l u d e d s i l i c a , a s b e s t o s , c o a l , t a l c ,

i r o n o r e , and many o t h e r m i n e r a l d u s t s ,

S i l i c o s i s i s a s p e c i f i c form of pneumoconiosis. It i s caused by t h e

i n h a l a t i o n of e x c e s s i v e amounts of s i l i c o n d i o x i d e i n t h e form of c r y s t a l l i n e

quartz. The d i s e a s e i s m a n i f e s t e d by n o d u l a t i o n of t h e lungs which i s a p p a r e n t

on an X-ray f i l m . Continued exposure t o s i l i c o n d i o x i d e c a u s e s t h e nodules

t o grow and u l t i m a t e l y l a r g e a r e a s o f t h e l u n g become s c a r t i s s u e which p r e -

v e n t s t h e l u n g from performing i t s p h y s i o l o g i c f u n c t i o n . I n i t s more advanced

s t a g e s , t h e r e i s a s i g n i f i c a n t l o s s of pulmonary f u n c t i o n which accounts f o r

* A s s i s t a n t C h i e f , D i v i s i o n o f O c c u p a t i o n a l H e a l t h , P u b l i c H e a l t h S e r v i c e , U. S.
Department o f H e a l t h , E d u c a t i o n , and Welfare. Washington, D O C . To be p r e s e n t e d
a t t h e annual m e e t i n g of t h e S o c i e t y of Mining Engineers of AIME, February 27 t o
Death may r e s u l t from c o m p l i c a t i o n s o f s i l i c o s i s , s u c h a s i n f e c t i o n o r h e a r t {
i
failure. S i l i c o s i s , a s b e s t o s i s , and a n t h r a c o s i l i c o s i s a,r/e p r o b a b l y t h e three I
I
most d i s a b l i n g forms o f pneumoconiosis. On t h e o t h e r hand, pneumoconiosis 1j
caused by t a l c , i r o n o r e , a n d , t h e s i l i c a t e s o t h e r t h a n a s b e s t o s are the least 'I
j
d i s a b l i n g forms of t h e d i s e a s e .

When t h e D i v i s i o n o f O c c u p a t i o n a l H e a l t h , U. S. P u b l i c H e a l t h Service,
1
was c r e a t e d some 50 y e a r s ago, s i l i c o s i s was probably t h e most s e r i o u s occu- I

I
p a t i o n a l d i s e a s e o c c u r r i n g i n American i n d u s t r i e s . I n a d d i t i o n t o mining, I
I
I
s i l i c o s i s was a s e r i o u s problem i n many o t h e r i n d u s t r i e s such a s g r a n i t e cutting,

t h e f o u n d r i e s , p o t t e r i e s , and i n t h e manufacture of v i t r e o u s t o i l e t f i x t u r e s ,

Much of t h e e a r l y work of t h i s D i v i s i o n was devoted t o a s t u d y of s i l i c o s i s i n

t h e m e t a l mining i n d u s t r y . I n v e s t i g a t i o n s c a r r i e d o u t by t h e P u b l i c Health

S e r v i c e and t h e U. S. Bureau of Mines between 1914 and 1935 i n d i c a t e d prevalence

f i g u r e s r u n n i n g a s h i g h a s 70 p e r c e n t . By t h e mid 1 9 3 0 ' s i t was b e l i e v e d that

t h e p a t h o l o g y and e t i o l o g y o f t h e d i s e a s e had p r o g r e s s e d t o t h e p o i n t t h a t pre-

v e n t i v e p r o c e d u r e s c o u l d be a p p l i e d and t h a t through t h e a p p l i c a t i o n of these

p r e v e n t i v e measures, t h e d i s e a s e would b e g i n t o l o s e i t s s i g n i f i c a n c e a s a

major c a u s e of m o r b i d i t y and m o r t a l i t y .

TO produce s i l i c o s i s , d u s t must have t h r e e c h a r a c t e r i s t i c s : (1) i t

must c o n t a i n c r y s t a l l i n e s i l i c o n d i o x i d e , s u c h a s q u a r t z ; (2) i t must be i n

t h e r e s p i r a b l e s i z e r a n g e , which i s l e s s t h a n f i v e . m i c r o n s i n s i z e ; and (3) i t

 3

ogram f o r t h e

l e which l e n d s i t s e l f t o c o n t r o l i s

t h e mid 1 9 3 0 ' s which demonstrated t o t h e

controlling or preventing s i l i c o s i s , Among

c o s i s Conference which was h e l d i n Washington

e s i d e n t a t t h e r e q u e s t of t h e S e c r e t a r y of

nown Gauley Bridge

l i t y t h e mining

i s e a s e , Thus,

was a c o n c e n t r a t e d e f f o r t , e s p e c i a l l y

adequate d u s t c o n t r o l programs,

t r o l programs was c l e a r l y demonstrated

n t h e metal mining i n d u s t r y conducted

Department of t h e I n t e r i o r , and t h e P u b l i c

t i o n s of 15,000 miners i n mines

d t h a t c o n s i d e r a b l e pro-

p r e v e n t i o n of s i l i c o s i s ,

t i a l l y lower t h a n r a t e s

g i n d i v i d u a l mines,
was n o t d i s t r i b u t e d u n i f o r m l y t h r o u g h o u t t h e i n d u s t r y . I t was a l s o shown t h a t

t h e r e was a s u b s t a n t i a l l y h i g h e r p r e v a l e n c e o f s i l i c o s i s among men who worked i n

/'
mining sometime b e f o r e 1935, as compared w i t h men who had worked t h e same

number o f y e a r s o n l y s i n c e 1935. The s t u d y a l s o d e m o n s t r a t e d t h a t t h e mining

i n d u s t r y had i n s t i t u t e d o r improved many d u s t m o n i t o r i n g and d u s t c o n t r o l

s y s t e m s d u r i n g t h e p a s t 25 y e a r s which had r e s u l t e d i n marked r e d u c t i o n s i n

dust exposures.

During t h e mid 1 9 3 0 ' s t h e D i v i s i o n of O c c u p a t i o n a l H e a l t h u n d e r t o o k a

s t u d y o f t h e a n t h r a c i t e mines i n e a s t e r n P e n n s y l v a n i a . Here t h e e x a m i n a t i o n

o f a p p r o x i m a t e l y 3,000 men i n s e v e n d i f f e r e n t a n t h r a c i t e mines d e m o n s t r a t e d t h e

p r e s e n c e o f a v e r y v i c i o u s d i s e a s e among a n t h r a c i t e m i n e r s , d e f i n e d a s anthraco-

silicosis. T h i s was a s e v e r e l y d i s a b l i n g form o f pneumoconiosis, c a u s e d by t h e

combined a c t i o n of c r y s t a l l i n e q u a r t z and a n t h r a c i t e c o a l . It was found t h a t

a b o u t 25 p e r c e n t o f t h e a n t h r a c i t e m i n e r s were a f f e c t e d , and t h a t t h e degree

o f t h e d i s e a s e was a E u n c t i o n o f t h e number o f y e a r s s p e n t i n t h e c o a l mines

and t h e d u s t c o n c e n t r a t i o n .

L a t e i n t h e 1 9 3 0 1 s , h e a l t h a u t h o r i t i e s i n Europe became concerned w i t h

t h e p o s s i b i l i t y o f a h e a l t h h a z a r d a s s o c i a t e d w i t h s o f t c o a l m i n i n g and t h e

B r i t i s h c o n d u c t e d m e d i c a l s t u d i e s of t h e i r m i n e r s s h o r t l y a f t e r World War 11,

T h i s r e v e a l e d t h a t a b o u t one i n f o u r o f t h e m i n e r s had some e v i d e n c e o f a c h e s t

d i s e a s e which was m a n i f e s t e d by d i s c r e t e n o d u l a t i o n of t h e l u n g s and f i b r o s i s ,

c o m p l i c a t e d by b r o n c h i t i s and emphysema. I n i t s e a r l y s t a g e , t h e d i s e a s e was

t h e l u n g s w i t h a s i g n i f i c a n t a l t e r a t i o n o f t h e normal pulmonary a r c h i t e c t u r e

and some a s s o c i a t e d f i b r o s i s . Although t h e r e v i e w o f t h e ~ ~ 3 a l a c h i ar enc o r d s

i n c l u d e d a r e l a t i v e l y l a r g e number o f c a s e s , t h e d a t a d i d n o t p e r m i t an

e s t i m a t e o f t h e p r e v a l e n c e of c h e s t d i s e a s e s i n t h e American bituminous c o a l

mining p o p u l a t i o n .

A f t e r r e v i e w i n g t h e s e d a t a , t h e D i v i s i o n o f O c c u p a t i o n a l H e a l t h began

t o p l a n a more d e f i n i t i v e s t u d y of t h e s i t u a t i o n i n t h e ' American mines, b u t

funds f o r t h e s u r v e y were n o t a p p r o p r i a t e d u n t i l f i s c a l y e a r 1963.

I n t h e meantime, however, D r . J a n Lieben of t h e Pennsylvania Department

o f H e a l t h conducted s t u d i e s which f u r t h e r e s t a b l i s h e d a r e l a t i o n s h i p between

bituminous c o a l mining and a h i g h r a t e of pneumoconiosis. One s t u d y covered

over 15,000 a c t i v e and r e t i r e d m i n e r s who v o l u n t e e r e d f o r medical examinations.

About 34 p e r c e n t of t h o s e examined i n c e n t r a l Pennsylvania, and about 14 percent

of t h o s e examined i n w e s t e r n P e n n s y l v a n i a showed X-ray evidence of c o a l miner's

pneumoconiosis.

I n t h e absence of d e f i n i t i v e i n f o r m a t i o n r e g a r d i n g t h e d i s e a s e , t h e

f i r s t s t e p w a s a more a c c u r a t e d e s c r i p t i o n of t h e d i s e a s e among American miners

and a n e s t i m a t i o n of i t s p r e v a l e n c e r a t e . With t h e c o o p e r a t i o n of t h e U. S.

Bureau of Mines, t h e American Mining Congress, t h e Bituminous Coal o p e r a t o r s 1

A s s o c i a t i o n . and t h e United Mine Workers of America, a random sample was .

s e l e c t e d o f 3 , 1 0 1 miners working i n T i t l e I1 mines i n t h e Appalachian a r e a ,

 I

August 1965 i s s u e o f t h e Mining Congress J o u r n a l . These p r o c e d u r e s w i l l a l s o

-..
I,
-- I

be d e s c r i b e d i n a forthcoming b u l l e t i n o f t h e P u b l i c H e a l t h S e r v i c e which 1
s h o u l d be a v a i l a b l e i n mid 1966. 1
1
f
The s t u d y r e v e a l e d t h a t almost one o u t o f e v e r y 10 bituminous c o a l
1I
m i n e r s i n t h e Appalachian f i e l d s had r a d i o g r a p h i c evidence o f c o a l workers
1
pneumoconiosis.

afflicted.
Among t h e i n a c t i v e m i n e r s , one i n f i v e , o r 20 p e r c e n t were

The p r e v a l e n c e of t h e d i s e a s e , d i v i d e d i n t o s i m p l e and complicated

i
i1
pneumoconiosis, f o r a c t i v e and i n a c t i v e m i n e r s i s shown i n T a b l e s 1 and 2 I
I

a c c o r d i n g t o age groups. T a b l e s 3 and 4 p r o v i d e p r e v a l e n c e f i g u r e s among active

and i n a c t i v e miners by y e a r s underground. The r e s u l t s a r e s t a r t l i n g when

1
a n a l y z e d a c c o r d i n g t o age and y e a r s underground. A c t i v e m i n e r s , aged 55 t o

64, s u f f e r over a 20 p e r c e n t r a t e o f pneumoconiosis. The proportTon of cases

i n c r e a s e s s h a r p l y among miners who have worked f o r more t h a n 20 y e a r s underground,

About t h r e e p e r c e n t o f t h e a c t i v e miners and about n i n e p e r c e n t of the 1

i n a c t i v e miners have p r o g r e s s e d from s i m p l e pneumoconiosis t o t h e more compli- ,1
c a t e d s t a g e o f t h e d i s e a s e g e n e r a l l y d e s c r i b e d as p r o g r e s s i v e massive f i b r o s i s
!l
o r PMF. PMF i s c h a r a c t e r i z e d by massive d e s t r u c t i o n o f t h e lung t i s s u e and i s
4

u s u a l l y a s s o c i a t e d w i t h s e v e r e emphysema. Once t h i s p r o g r e s s b e g i n s , i t pro- I

g r e s s e s r a p i d l y c a u s i n g a n i n c a p a c i t a t i n g d e g r e e of b r e a t h l e s s n e s s and usually
1
r e s u l t s i n d e a t h from h e a r t f a i l u r e , There i s no known t r e a t m e n t o r therapy I

which would a l t e r t h e c o u r s e of t h e d i s e a s e .

I
 9

Richwopd l e f t

I n t h e non-mining

dence of t h e c h e s t

y s i s of d e a t h r a t e s f o r American

t was found t h a t t h e d e a t h r a t e f o r

r k i n g male p o p u l a t i o n , w h i l e

expectancy o f t h e American c o a l

han t h a t of t h e B r i t i s h c o a l miner,

n s i v e r e s p i r a t o r y and p a t h o l o g i c

e Beckley Memorial H o s p i t a l .

rovided dramatic e v i -
 10

F i g u r e 2 shows t h e e a r l y s t a g e s of c o a l w o r k e r ' s pneumoconiosis i n which

t h e d u s t i s beginning t o l o c a l i z e and s i g n s of emphysema a r e v i s i b l e i n t h e .

lungs. It i s a l s o e v i d e n t t h a t t h e pulmonary s t r u c t u r e i s s l i g h t l y d i s t o r t e d .

F i g u r e 3 i s t h e lung of a miner who was s u f f e r i n g from t h e advanced

s t a g e of t h e d i s e a s e , p r o g r e s s i v e massive f i b r o s i s . Here t h e d u s t f o c i have

conglomerated and huge a r e a s of t h e lung have c a v i t a t e d . The lungs a r e obviously

f i b r o t i c w i t h widespread a r e a s of emphysema.

Although t h e s t u d y d i d n o t permit t h e c o n c l u s i o n t h a t pneumoconiosis

among bituminous c o a l miners r e s u l t s from t h e i n h a l a t i o n of c o a l d u s t , i t

i s abundantly c l e a r from r e s e a r c h i n t h e United ~ i n ~ d oand

m Europe t h a t there

i s a d i r e c t r e l a t i o n s h i p between d i s e a s e and d u s t c o n c e n t r a t i o n s i n t h e working

environment. It i s a l s o e v i d e n t from r e s e a r c h i n t h e s e two p a r t s of t h e world

t h a t t h e r e i s a c l o s e r c o r r e l a t i o n between d i s e a s e c o n d i t i o n and t h e t o t a l mass

of i n h a l e d d u s t less t h a n f i v e microns i n s i z e , t h a n t h e r e i s w i t h t o t a l particle

count. A s you know, t h e p r e s e n t American s t a n d a r d i s based on p a r t i c l e count.

R e p r e s e n t a t i v e s of t h i s D i v i s i o n r e c e n t l y a t t e n d e d an i n t e r n a t i o n i l con-

f e r e n c e i n London which was d i r e c t e d t o t h e development i f an i n t e r n a t i o n a l dust

s t a n d a r d f o r c o a l mining. Although t h e a d o p t i o n of an i n t e r n a t i o n a l standard

may be some y e a r s i n t h e f u t u r e , i t i s e v i d e n t t h a t t h e s t a n d a r d w i l l bi a
I
r e s p i r a b l e mass one, e x p r e s s e d a s m i l l i g r a m s of d u s t l e s s t h a n 5 microns per

c u b i c meter of a i r . For example, t h e Netherlands have adopted a r e s p i r a b l e

 / mass s t a n d a r d which i s i l l u s t r a t e d i n F i g u r e 4. Until further studies are

I conducted i n t h e United S t a t e s , however, w e s h a l l have t o c o n t i n u e t o u s e t h e

u n o f f i c i a l s t a n d a r d o f 20 m i l l i o n p a r t i c l e s p e r c u b i c f o o t of a i r a s a g u i d e l i n e .

S t u d i e s soon t o be i n i t i a t e d by t h e Bureau of Mines and t h e P u b l i c H e a l t h S e r v i c e

w i l l be d i r e c t e d a t d e f i n i n g e t h e environmental c o n d i t i o n s i n t h e bituminous

mines w i t h p a r t i c u l a r r e f e r e n c e t o d u s t c o n c e n t r a t i o n s i n terms of r e s p i r a b l e

mass, and t h e development o f more a d e q u a t e methods of d u s t c o n t r o l .

Ii I n t h e meantime, however, t h e mining i n d u s t r y must r e c o g n i z e t h a t i t i s

f a c e d w i t h an a c u t e problem. The c o n t i n u e d mechanization of t h e mines w i l l

p r o b a b l y add t o t h e s e r i o u s n e s s o f t h e problem by i n c r e a s i n g t h e t o t a l d u s t

l o a d i n t h e working atmosphere. The s o l u t i o n t o t h e problem l i e s i n a c o o r d i n a t e d

r e s e a r c h program between i n d u s t r y and t h e Government a g e n c i e s concerned. The

f i r s t s t e p i n t h i s d i r e c t i o n was r e c e n t l y t a k e n by t h e American Mining Congress

and t h e Bituminous Coal O p e r a t o r ' s A s s o c i a t i o n w i t h t h e appointment of a t e c h n i c a l

l i a i s o n committee from i n d u s t r y t o work w i t h a j o i n t committee from t h e Bureau

/ o f Mines and t h e P u b l i c H e a l t h S e r v i c e .
 Table 1. P

Age
(in years)

A 1 1 ages

Under 25