The value placed on the life of newborns is less than that expected according to predicted clinical outcomes and current legal and ethical theory relative to best interests. Value assessments on the basis of age, disability and prognosis appear to transcend culture, politics and religion in this domain.

ABSTRACr From a continuous series of 886 postmortem examinations on coal mine workers in New South Wales, Australia, from 1949 to 1982 and their histories the following data were obtained: age at death (886 cases), percentage of emphysema in both lungs (Heard method) (870 cases), bronchial gland wall (G-W) ratio (Reid Index) (412 cases), chest radiograph within 10 years of death (792 cases), history of work at the coal face (844 cases), history of amount of tobacco smoked (606 cases), and FEV, five years before death (278 cases). Linear regression analysis showed the following: (1) The severity of emphysema had a significant positive regression on years of face work independently of age at death. (2) The severity of emphysema had a significant positive regression on the severity of x-ray pneumoconiosis, which was best defined in the non-smoking group and the non-bronchitic group. (3) There was a significant multiple linear regression relationship between severity of emphysema (dependent variable) and pneumoconiosis and G-W (independent variables). The ratio of standardised regression coefficients was pneumoconiosis: G-W = 3:1. (4) The severity of x-ray pneumoconiosis had a significant positive regression on years of face work and a negative regression on smoking amount. (5) G-W ratio had significant positive regressions on age of death and severity of emphysema but not years of face work or severity of pneumoconiosis. (6) Smoking was not correlated with severity of emphysema or G-W ratio. (7) FEV, (% predicted) was significantly negatively correlated with bronchitis, emphysema, and pneumoconiosis. (8) Severity of pneumoconiosis and emphysema have declined slightly but significantly over the 33 year period, but there has been no significant change in G-W ratio during 1960-82.The analyses of postmortem data obtained from the lungs of 186 coal workers and associated clinical and physiological data from the same workers have allowed several conclusions to be drawn about pneumoconiosis, emphysema, and bronchitis in the coal industry.' The main conclusions were:(1) There is a quantitative relationship between the severity of emphysema postmortem and the postmortem severity of pneumoconiosis or x-ray pneumoconiosis in radiographs taken less than five years before death.(2) Both postmortem emphysema and postmortem pneumoconiosis are quantitatively related to

The period prevalence of simple chronic bronchitis (SCB) (mucus hypersecretion), defined as chronic cough and sputum production by the MRC respiratory symptom questionnaire administered by occupational physicians and of obstructive chronic bronchitis (OCB) (airflow obstruction) (defined as SCB plus FEV, < 80% predicted) have been measured over the period 30 June 1977-30 June 1980 in the entire work force aged between 21 and 60 of the coal industry of New South Wales, Australia (12 357 men). Four dimensional contingency table analysis by a logistic transform method showed highly significant (p < 0-001) additive affects of age (exposure duration), site of work, smoking, and alcohol consumption on development of overall chronic bronchitis (SCB + OCB). Odds ratios were face work: surface work = 178:1, smoker: non-smoker = 4-23:1, alcohol >300 g/wk: alcohol <300 g/wk = 2-13:1. There was no evidence for synergistic effects of these factors on the development of mucus hypersecretion. When OCB was analysed separately, the effect of site of work, although in the same direction, was not statistically significant and this was assumed to be due to a "healthy worker" effect or a "swamping" effect of smoking. Age, smoking, and alcohol effects were highly significant (p < 0-0001) and there was a sharp increase in prevalence of OCB in the age groups 41-50 and 51-60. Odds ratios were face work: surface work = I 11:1, smoker: non-smoker = 2-66: 1, alcohol >300 g/wk: alcohol <300 g/wk = 2-91:1. There was no evidence of synergistic effects. These results are consistent with a hypothesis of additive effects of smoking, alcohol, and coal mine dust and fumes on the development of chronic mucus hypersecretion leading to airflow obstruction or a hypothesis of similar additive effects on the development of two separate conditions-mucus hypersecretion with airflow obstruction and mucus hypersecretion without airflow obstruction.The relative importance of occupational factors in the coal industry in the aetiology of simple chronic bronchitis (SCB) and obstructive chronic bronchitis (OCB) is still undecided.' Studies in the United Kingdom show a progressive decrement of FEV1 with increasing exposure to dust,2 -but only respirable dust (1-5 p) was quantified, and it is thought that particles > 5p are more likely to be important in causing bronchitis.5 In the United States a decreasing gradient of bronchitis prevalence between face, underground non-face, and surface workers has been shown, most

Central lymph node changes and progressive massive fibrosis in coalworkers SIR,-We were very interested in the "central hypothesis" for the aetiology of progressive massive fibrosis in coalworkers proposed by Dr RME Seal and colleagues (July

Objectives Isolated fetal ascites carries an uncertain prognosis and broad differential diagnosis. When detected on prenatal sonography, a thorough evaluation is warranted to exclude development of hydrops and search for an underlying condition. While gastrointestinal abnormalities account for approximately 20% of cases of fetal ascites, surgical correction is commonly required postnatally. While there have been reports of isolated fetal ascites resolving in utero, spontaneous resolution of the causative gastrointestinal abnormality is unusual. Case presentation We report a case of a multiparous 33-year-old found to have moderate fetal ascites and a complex fetal abdominal mass near the small bowel detected by ultrasound at 32 weeks with spontaneous resolution of both ascites and mass by 37 weeks. Following the delivery of a normal neonate, we suspect the mass and ascites to have been produced by a small bowel rupture resulting in meconium peritonitis. Conclusions When fetal ascites with late gestational onset has spontaneous resolution in utero and hydrops never develops, there is generally a favorable prognosis and normal neonatal outcome.