History and Geography

For many centuries, medical observers, and workers and their employers, have recognized respiratory distress and its consequences as an occupational hazard among underground miners and employees of industries that generate considerable dust (notably refineries, foundries, and the manufacturing of cotton, flax, and hemp). Pliny described the inhalation of

"fatal dust" in the first century. In the sixteenth century, Agricola observed that miners, physicians, and engineers were aware of shortness of breath and premature death. In the early nineteenth century, pathologists observed that some miners in Scotland had black lesions on the lung at autopsy. The term pneumoconiosis appears to have been invented in 1867. Brown lung seems to have been named by analogy with black lung, apparently in the 1960s.

The contemporary, imprecise medical synonym for black lung is coal workers' pneumoconiosis (CWP). CWP occurs in two forms: simple CWP and progressive massive fibrosis. Both forms have characteristic lesions. Agencies awarding compensation for disability usually use the designation "black lung" as a rough synonym for pathologically defined CWP and for obstructive airways disease among coal miners.

Most medical authors, epidemiologists, and agencies awarding compensation usually use "brown lung" as a popular synonym for byssinosis or chronic dust-induced respiratory disease (CDIRD). The pathology in these descriptions resembles that of chronic bronchitis.

The rich literature on the history and geography of black and brown lung cannot be summarized in conventional terms. Many authors have attempted to describe the history of these conditions, but they have almost invariably done so on the basis of the precise definition of symptomatology accepted at the time they were writing. The reported geography of the conditions is consistent with the distribution of industries in which dust is a by-product, but the perception of the conditions in particular places (and by later observers) has determined what is said, in retrospect, about their geography.

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