THE MINERS' PHTHISIS OF THE RAND. 



By Wilfred Watkins-Pitchford, M.D., F.R.C.S., D.P.H. 



The gold-mining industry is at the present time the most 

 important industry of South Africa. Like so many of the 

 principal industries of the world, it has its special industrial 

 disease, and the nature and characters of this particular disease 

 cannot fail to be of engrossing interest to all Africanders of 

 liberal mind. 



The limitations of the space at my disposal preclude any ex- 

 haustive treatment on the subject; I propose, therefore, to omit 

 all reference to the statistical and economic sides of the matter, 

 and to review briefly the salient points in the causation of the 

 disease, and the essential characters of the changes which it 

 produces in the lungs. 



Considerable misunderstanding exists as to the exact scope 

 of the terms pulmonary silicosis and miners' phthisis. In general 

 it may be said that although the terms are synonymous, the 

 technical discrimination lies in the fact that pulmonary silicosis, 

 or briefly silicosis, does not become miners' phthisis until the 

 affected lungs are invaded by the tubercle bacillus. 



Pulmonary silicosis implies an excess of silica in the lung 

 tissues, and the direct effect of this excess of silica is to pro- 

 duce an overgrowth of the connective tissue of the organ, and 

 thus impair its function. The condition so established is rarely 

 fatal in itself ; the fatality is usually consequent upon an infec- 

 tion of the damaged lungs by the tubercle bacillus. 



In illustration of the fact that silicosis by itself is not neces- 

 sarily a fatal disease. I may state that I have recently examined 

 the lungs of a man who worked underground for eight years, 

 when the conditions of labour were very bad, and who, as the 

 microscope showed, developed silicosis during this time. He then 

 quitted his underground occupation and, seven years afterwards, 

 died of the ordinary type of pneumonia to which we are all liable. 



The infection of the silicotic lung by the tubercle bacillus 

 gives rise to a form of phthisis (miners' phthisis), w^hich differs 

 from the ordinary form of consumption in two important re- 

 spects. In the first place the tuberculous infection very rarely, 

 if ever, spreads to other organs of the body, and, secondly, the 

 infection is very rarely communicated to other people — unless 

 their lungs also have been previously damaged by silicosis. 



Pulmonary silicosis is caused by the inhaling of air in 

 which particles of silex are floating, and the forced respiratory 

 movements which occur during severe muscular exertion facili- 

 tate the entrance of the dust-laden air into the deeper air pas- 

 sages. All the silica detectable in lung tissue has entered the 

 body with the inspired air; the swallowing of siliceous dust, i.e., 

 taking it into the stomach, is incapable of producing pulmonary 

 silicosis. Although silica is so abundant in the bodies of certain 



