Report of the Royal Commissioner on Pulmonary Diseases amongst Miners, together with Appendices and Minutes of evidence, Perth, 4th October, 1910.

  • Western Australia
Date:
1910
Catalogue details

Licence: In copyright

Credit: Report of the Royal Commissioner on Pulmonary Diseases amongst Miners, together with Appendices and Minutes of evidence, Perth, 4th October, 1910. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    53/146 page 49
    There will he produced: later, evidence that there is nothing- in I lie way of “mine infection,” if by that term is meant infection of the soil or of the rock. When a man is working- with a consumptive in the close proximity necessitated in many sections of mine work, then the wonder is that he does not g-et tuber- culosis; and 1 am inclined to think that part of the explanation of the excessive incidence of tuberculosis on machine men is due to the confined space in which the two men engaged on a machine have to work, whereby the probability of infection is largely in- creased. Undoubtedly the dust, by the damage it does to the lung tissue, does also play an important part, but if it were to be regarded as the factor of primary importance, then it would be difficult to understand why so few cases of tuberculosis were met with. The facts given on page relating to the con- ditions found in the body of a miner killed in an accident have a very striking- significance in this con- nection. This man was accidentally killed while apparently in perfect health, and on examination of the lungs at the post mortem it was found that the bronchial gland was extensively invaded by tuber- culosis. The importance of infection had by this time become so firmly established in my mind that the hypothesis was at once formed that either some member of his family had tuberculosis or that he had been working with a man so affected. Enquiry revealed the fact that one of his brothers is at the present time under treatment for tuberculosis. The facts with regard to this case, as well as the authority for the above statement, are given on page One other striking fact was revealed by the study of these tubercular cases. Of the 64 cases (which included those under treatment at the Sanatorium at the time of my visit) there were 13 who had con- tracted their infection at the Fingall mine. This fact was very carefully verified, and the connection be- tween the successive cases occurring at that mine was clearly traceable. This was the local focus of infection referred to on page 47. and there can be little reasonable doubt when the facts in this table are considered, together with the fact brought out in the study of the statistics for the past ten years that tuberculosis is steadily on the increase amongst miners, that unless steps are taken to deal with this tuberculous infection there will sooner or later be other foci of infection, for the affected men are bound not to remain long in the one place. The indication is clear: it is the consumptive only—not the mine or anything else, but the consumptive—who produces consumption. Another aspect of this question is worthy of atten- tion. A child was brought to me for examination. It had definite tuberculosis of the glands of the neck. Its father, a miner, had recently died from tubercu- losis of the lungs in the Coolgardie Sanatorium. The significance of this case is obvious. But if Table Q. (page 59) be again referred to, it will be seen that in several instances the source of infection was not a fellow-miner, but a person entirely unconnected with the mining industry. Nos. 27, 32, 19, and 57 illustrate this point. Hence, any measures against tuberculosis which are intended to be entirely comprehensive must pay attention to sources of infection, not only amongst miners but amongst the general population. Tl is a matter of some importance to determine whether this infectivity of tuberculosis amongst miners is peculiar to miners, or is part of a general law relating to this disease throughout the whole population. On pages 83-85 is given a reprint of an article which appeared in the June number of the journal, Public Health (1909). The article sufficiently re- veals its own scope, and the only fact of importance to be quoted here is that it was established clearly, that of 127 cases of tuberculosis of the lungs reported to the Central Board of Health of Western Aus- tralia during 1909, a total of 43, or 33.8 per cent., were due to personal infection from a consumptive person. In Table Q. there are 65 cases given, and of these 32, or 49.2 per cent., showed a clear history of in- fection. This question was tested in another way. All the males at the Sanatorium at Coolgardie were carefully questioned. There were 31 of these (excluding ex- miners, who are included in Table Q.), and of these 14, or 45.2 per cent.,, gave a clear history of infection, while four were doubtful. The facts relating to these 18 cases are given in detail in Table R. Still again, to check the correctness of this hypo- thesis of infection in tuberculosis, the case-books at the Sanatorium were examined, with the following result:—■ The total number of consumptives treated at the Sanatorium from the time of its inception until June 13, 1910, was 342. The clinical histories of 178 of these are available. These clinical histories are some- times far from complete; but despite this incom- pleteness, 50 histories, i.e., 28 per cent., show clear evidence of personal infection. So that, however the hypothesis be tested, it is absolutely incontrovertible that tuberculosis of the lungs must be regarded as an infectious, rather than as an industrial, disease. Certainly there are occu- pations which facilitate tubercular infection; but measures which attack the disease from the industrial end have small hope of success in comparison with measures planned entirely with regard to the infec- tivity of the disease. That these statements are not merely the expres- sion of one person’s opinion is clearly evidenced by the resolutions adopted at the International Congress on Tuberculosis, held at Washington, U.S.A., in 1908. The resolutions were as follows;— “ That the utmost efforts should be continued in the struggle against tuberculosis to prevent the conveyance of tuberculous infection from man to man as the most important source of the disease.” “That preventive measures be continued against bovine tuberculosis, and that the possi- bility of the propagation of this to man be recognised.” “That this Congress urge upon the public and upon all Governments (a) the establishment of hospitals for the treatment of advanced cases of tuberculosis; (b) the establishment of sana- toriums for curable cases of tuberculosis; (c) the establishment of dispensaries, etc., for cases which cannot enter sanatoriums or hospitals.”
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