The Pulmonary Disability Legislation of South Africa: A Rationale for Its Enactment

Our plain-English summary of The Pulmonary Disability Legislation of South Africa: A Rationale for Its Enactment, by G W H Schepers (1955).

The study

• Author: G W H Schepers
• Published: Saranac Laboratory, Saranac Lake, N.Y.; recorded for publication April 7, 1955
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1955 paper by G. W. H. Schepers, director of the Saranac Laboratory, explained and defended South Africa's 1952 pulmonary disability law, which amended the Silicosis Act. The law defined 'pulmonary disability' as lasting impairment of heart and lung function from work in a dusty occupation that substantially and permanently reduced capacity for manual work, excluding silicosis and tuberculosis. It covered other mines with respiratory hazards as well as gold mines. The author analysed certification data from Witwatersrand gold miners. In a group of 155 disability cases without silicosis on X-ray, most men were disabled before their 18th year of dusty work. Silicotics and tuberculosilicotics were older than men with pulmonary disability. Few cases were found among 'Negro laborers'. The author described the condition mainly as chronic bronchitis, emphysema and cor pulmonale. The author cautioned that the cases built up over several earlier years and that some trend curves were reconstructed. Asbestosis was mentioned only once, as an example of lung fibrosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary on legislation, with a descriptive analysis of certification statistics and clinical, X-ray and pathology observations
• Who was studied: White miners and 'Negro laborers' on South African gold mines of the Witwatersrand. One analysis covered a group of 155 men with pulmonary disability and no silicosis visible on X-ray.
• Exposure: Mine dust, especially quartz dust, in gold mines. The legislation also covered other types of mines with respiratory hazards. Asbestos was not studied; asbestosis was mentioned only as one example of massive lung fibrosis.
• Main results:
  • Most men in the group of disability sufferers had become functionally incapacitated before the 18th year of their service in dusty occupations.
  • Silicotics and tuberculosilicotics were on average older than men certified with pulmonary disability. Only tuberculotics were on average younger.
  • Yearly rates of third- and second-stage silicosis on X-ray had fallen over the previous 40 years.
  • The number of pulmonary disability cases among 'Negro laborers' was surprisingly low, given the larger numbers of new silicosis and tuberculosis cases among them. The author suggested this may be because most were relatively young men who spent a short time in the mines.
  • Over this period, miners survived longer, worked longer, and developed less tuberculosis and silicosis on X-ray.
  • Under the law, second-stage pulmonary disability was treated as equal to third-stage silicosis in degree of severity.
• The authors' conclusion: The author concluded that the main clinical picture of pulmonary disability rested on a triad of chronic bronchitis, emphysema and cor pulmonale.
• Limitations the authors state:
  • The cases had built up over many previous years, so some men may have developed disability first and silicotic nodules later.
  • The case figures included a five-year retroactive backlog that the law took into account.
  • The trend curves for pulmonary disability in the figure were not directly observed but were reconstructed.

Topics

Medical terms in this study, explained in our Lexicon: Saranac Laboratory, Silicosis, Emphysema, Cor Pulmonale, Fibrosis.

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