During a recent study of rheumatic complaints among coal-miners, the incidence of similar complaints in the general population of a Lancashire town was investigated, and information was collected about occupational, climatic, and other possible factors which might be related to these complaints. Details of the method of survey and its completeness have already been discussed (Lawrence and AitkenSwan, 1952) so that the method of study need only be summarized here. Method The survey was carried out during 1949-50 in Leigh. This is an industrial town in South Lancashire which, according to the 1951 census, had a population of 48,714. A random sample was taken of every tenth house and all individuals normally resident at that address and over the age of 15 years were interviewed by a specially trained medico-social worker. Each individual was asked whether he or she had suffered from rheumatism or from lumbago, sciatica, fibrositis, arthritis, neuritis, or any other aches or pains during the past 5 years, or before. Similar complaints present at the time of interview were also recorded. If a positive answer was given to any of these questions, information was collected about the site of pain, its duration, and any resulting loss of working time. Details of the individual's occupation and any unusual climatic exposure, past injury, or mechanical stress at work were also recorded, together with the type of dwelling. A list of houses officially classified as damp was also provided by the council inspector.All individuals with rheumatic complaints were subsequently visited by a member of the medical staff of the University Rheumatism Centre. This physician checked the history and carried out a simple clinical examination designed to exclude complaints due to non-rheumatic diseases, and where possible to classify the rheumatic complaints under certain agreed diagnostic headings.Unfortunately the diagnostic criteria for most rheumatic diseases are not clearly defined. The more advanced stages of diseases such as rheumatoid arthritis, ankylosing spondylitis, and osteo-arthritis can be recognized with some certainty, but the large variety of more transient painful syndromes which are usually called "fibrositis", "neuritis", or "lumbago" are less easily defined. Where 5 the history and physical signs were definite enough for a diagnosis, such as rheumatoid or osteo-arthritis, to be made with reasonable confidence, this was recorded as the cause of pain, but where the diagnosis was uncertain the cause of pain was given as "undetermined", thus avoiding such vague terms as "lumbago" and "fibrositis".During the past decade much attention has been given to disorders of the intervertebral disks, and it has become fashionable to attribute certain types of brachial, sciatic, and back pain to prolapse or degenerative changes in these disks. An attempt was therefore made to separate these conditions from the mass of painful disorders of undetermined nature. Only a few of those placed in this category were considered to have had a def...
Much has been written about the heavy toll of rheumatism in industry (Kahlmeter, 1923;Newman, 1924;Horder, 1944), but there is little precise information as to its incidence in the general population. Such information as exists indicates that some 3% of the insured population are incapacitated each year because of the rheumatic diseases (Report on Incapacitating Sickness in the tnsured Population of Scotland, 1930-36). The proportion of the population consulting general practitioners is rather similar, varying from 2 8°' in the south of England to 4-3% in the north of Scotland (Newman, 1924;Davidson and Duthie, 1937). The consultation and incapacity rates, however, are but a poor guide to incidence, and this applies perhaps to the rheumatic diseases more than to any others. Popular belief in the incurability of these disorders is strongly held and induces an attitude of resignation which the medical profession has so far done little to dispel.The nearest attempt to a determination of total rheumatic incidence is that reported by Stocks (1949) based on a sickness survey for the Central Office of Information. From this survey a monthly incidence of 18% of rheumatic diseases in the population is deduced. This, however, is based onself-diagnosis.On the incidence of rheumatism in miners information is even less definite, but there have been indications that it is higher than in the general population. Thus in Scotland in 1938, 5%h of miners were incapacitated from this cause. This figure may be compared with an incapacity rate of 3% in metal and transport workers and in general labourers, and 2% in the remaining occupation groups studied. The incapacity rate was thus roughly twice as great in miners, and the increase was distributed equally amongst joint, muscular, and neuritic forms (Scottish Report on Chronic Rheumatic Diseases, 1945). Method of StudyThe present investigation was undertaken at the request of the Miners' Welfare Commission and was carried out in the Manchester coal fields. A preliminary survey in a number of pits in the area revealed the practical difficulties which would result from the application of random sampling methods to an underground population, and it was decided to survey the entire population of one mine. For this purpose the Bedford Colliery at Leigh was chosen. In addition a survey was made of the following groups: (1) the workers at an engineering yard belonging to the National Coal Board: (2) office staff employed at the Area Headquarters of the National Coal Board; (3) the Bedford miners' families; and (4) a random sample of the town of Leigh.Bedford Colliery.-Bedford is a medium-sized colliery employing just over 1,000 men. Of these some 80% work underground, 43% at the coal face, and the remainder on the roadways or at miscellaneous sites. At the time of the survey three seams were being worked. Two of these were machineoperated and had a roof-height of 3 ft. 3 in. The third was higher, 6 to 8 ft., and worked by hand. It has since been closed.
IT is now generally accepted that cancer of the cervix is predominantly a disease of parous married women of middle age, particularly those who marry under age 20, who have had more than one partner and who are the wives of men in the loxver socio-economic groups. Numerous studies have confirmed these findings. The method used has usually been a comparison of patients and variously selected control groups. In the United Kingdom studies of the amount of the disease or its distribution in different population groups have generally been based on mortality statistics. These are subject to errors of certification; also, as treatment becomes more effective deaths will give an even less complete picture of incidence. Epidemiological studies of the incidence of cervical cancer are becoming possible as cancer registration improves its coverage but there is still little information on the number of women suffering from it and none on how these women compare in age at marriage and family size with the whole community of which they are a part.In Scotland less is known of the distribution of the different types of uterine cancer than in England and Wales due to the failure of many Scottish death certificates to specify the exact site of the disease. In England and Wales the proportion thus unspecified had been reduced to 5 per cent soon after 1950, the year when attempts were first made to differentiate between cancer of the cervix and corpus uteri in death certificates. In Scotland the proportion with site unspecified was still 27 per cent in 1964. We do not know, therefore, if mortality from cervical cancer, as for many other diseases, is higher in Scotland than in England and Wales or to what extent in Scotland it follows the pattern of higher rates in cities and sea-ports compared with smaller towns and rural areas. Knowledge of where the disease is most common, how much of it there is and which women are most at risk has a practical bearing on aetiology, prevention and control. Population and PatientsThe comparatively isolated character of North-East Scotland, a fairly static population and centralisation of treatment of cervical cancer in the city of Aberdeen have helped to ensure that practically all cases occurring in a defined area over a period of years (1944( -63 Aberdeen city, 1950 Aberdeen county) can be identified. A few patients seen at home by a gynaecologist might not be referred to a hospital at all because their lesion was too far advanced, but their
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