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‘X-rays don't tell lies’: the Medical Research Council and the measurement of respiratory disability, 1936–1945

  • COREEN MCGUIRE (a1)

Abstract

During the first half of the twentieth century, the mining industry in Britain was subject to recurrent disputes about the risk to miners’ lungs from coal dust, moderated by governmental, industrial, medical and mining bodies. In this environment, precise measurements offered a way to present uncontested objective knowledge. By accessing primary source material from the National Archives, the South Wales Miners Library and the University of Bristol's Special Collections, I demonstrate the importance that the British Medical Research Council (MRC) attached to standardized instrumental measures as proof of objectivity, and explore the conflict between objective and subjective measures of health. Examination of the MRC's use of spirometry in their investigation of pneumoconiosis (miner's lung) from 1936 to 1945 will shed light on this conflict and illuminate the politics inherent in attempts to quantify disability and categorize standards of health.

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Copyright

Footnotes

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This work was supported by the Wellcome Trust (grant no 103339) as part of the Life of Breath project. I would like to thank the Life of Breath team for their helpful comments on the presentation of this work. I am further indebted to Havi Carel, Graeme Gooday and Richard Bellis for their vital criticism and editorial remarks on earlier drafts. Special thanks to Lundy Braun for discussing her research on historical spirometry at the University of Bristol in March 2018. I am also grateful to Marie Thebaud-Sorger, Stephen Mawdsley, Sally Horrocks, Charlotte Sleigh and the two anonymous referees for their assistance with this work.

Footnotes

References

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1 Edgar King to Fred Swift, 20 November 1923, Somerset Miners’ Association, Bristol University Library Special Collections (henceforth SMA), DM 443, Box 6.

2 Hutchinson, John, Contributions to Vital Statistics, Obtained by Means of a Pneumatic Apparatus for Valuing the Respiratory Power with Relation to Health, London: Statistical Society of London, 1844, p. 2, emphasis in original.

3 See Booth, Sara, Chin, Chloe and Spathis, Anne, ‘The brain and breathlessness: understanding and disseminating a palliative care approach’, Palliative Medicine (2015) 29(5), pp. 396398; and Spathis, Anna, Booth, Sara, Moffat, Catherine, Hurst, Rhys, Ryan, Richella, Chin, Chloe and Burkin, Julie, ‘The breathing, thinking, functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory illness’, NPJ Primary Care Respiratory Medicine (2017) 27, pp. 16.

4 Carel, Havi, Macnaughton, Jane and Dodd, James, ‘Invisible suffering: breathlessness in and beyond the clinic’, The Lancet (2015) 3, pp. 278279, 278.

5 See www.lifeofbreath.org; and Macnaughton, Jane and Carel, Havi, ‘Breathing and breathlessness in clinic and culture: using critical medical humanities to bridge an epistemic gap’, in Atkinson, Sarah, Woods, Angela, Whitehead, Anne and Richards, Jennifer (eds.), The Edinburgh Companion to the Critical Medical Humanities, Edinburgh: Edinburgh University Press, 2016, pp. 294309.

6 Williams, Tina and Carel, Havi, ‘Breathlessness: from bodily symptom to existential experience’, in Aho, Kevin (ed.), Existential Medicine: Essays on Health and Illness, London: Rowman & Littlefield, 2018, pp. 145254.

7 Direct measurements of physiology can only pertain to height or weight. For other measurements surrogate parameters must be used; that is, measuring something by measuring something else. See Gooday, Graeme, The Morals of Measurement: Accuracy, Irony, and Trust in Late Victorian Electrical Practice, Cambridge, Cambridge University Press, 2004.

8 Bloor, Michael, ‘The South Wales Miners Federation, miners’ lung and the instrumental use of expertise, 1900–1950’, Social Studies of Science (2000) 30(1), pp. 125140; Melling, Joseph, ‘Beyond a shadow of a doubt? Experts, lay knowledge, and the role of radiography in the diagnosis of silicosis in Britain, c.1919–1945’, Bulletin of the History of Medicine (2010) 84, pp. 424426.

9 Linker, Beth, ‘On the borderland of medical and disability history: a survey of the fields’, Bulletin of the History of Medicine (2013) 87(4), pp. 499535, 499.

10 Carel, Havi and Cooper, Rachel, Health, Illness and Disease: Philosophical Essays, Durham: Acumen Publishing, 2013, p. 10.

11 See Barnes, Elizabeth, The Minority Body, Oxford: Oxford University Press, 2016; Elselijn Kingma, ‘Health and disease: social constructivism as a combination of naturalism and normativism’, in Carel and Cooper, op. cit. (10), pp. 37–56.

12 Foucault, Michel, The History of Sexuality, vol. 1, London: Penguin Books, 1976, p. 139; Hacking, Ian, ‘Biopower and the avalanche of printed numbers’, Humanities in Society (1982) 5, pp. 279295; Davis, Lennard J., The End of Normal: Identity in a Biocultural Era, Ann Arbor: University of Michigan Press, 2013.

13 Davis, Lennard J., Enforcing Normalcy: Disability, Deafness, and the Body, New York: Verso, 1995.

14 Kohrman, Matthew, ‘Why am I not disabled? Making state subjects, making statistics in post-Mao China’, Medical Anthropology Quarterly (2003) 17(1), pp. 524.

15 Hutchinson had previously worked for life insurance companies.

16 Pepys, Jack and Bernstein, Leonard, ‘Historical aspects of occupational asthma’, in Bernstein, Leonard, Chan-Yeung, Moira and Malo, Jean-Luc (eds.), Asthma in the Workplace, New York: Marcel Dekker, Inc. 1999, pp. 935.

17 Hutchinson, op. cit. (2).

18 Hutchinson, op. cit. (2), p. 2.

19 Braun, Lundy, Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics, Minneapolis: University of Minnesota Press, 2014, p. 8.

20 To say that a kind is natural is to say that it corresponds to a grouping that reflects the natural world rather than the interests of humans. This is a complex debate within philosophy that this article does not have scope to explore, but it is worth noting that we think classifications in science should (if successful) correspond to nature, and there is much debate about whether things like races, sexes and diseases are natural or social kinds.

21 Braun, op. cit. (19).

22 Bowker, Geoffrey C. and Star, Susan Leigh, Sorting Things Out: Classification and Its Consequences, Cambridge, MA: MIT Press, 1999.

23 For comparative arguments about the objectivity and power of numbers in biopolitics see Porter, Theodore, ‘Focus article: measurement, objectivity, and trust’, Measurement: Interdisciplinary Research and Perspectives (2003) 1(4), pp. 241255; Hacking, op. cit. (12).

24 Dreyer, Georges, ‘The normal vital capacity in mean and its relation to the size of the body’, The Lancet (1919) 194, pp. 227234.

25 Smith, David and Horrocks, Sally, ‘Defining perfect and not-so-perfect bodies: the rise and fall of the “Dreyer method” for the assessment of physique and fitness, 1918–26’, in Sobal, Jeffrey and Maurer, Donna (eds.) Weighty Issues: Fatness and Thinness as Social Problems, London: Routledge, 1999, pp. 7494.

26 Dreyer, op. cit. (24), p. 227.

27 Dreyer, Georges, The Assessment of Physical Fitness: By Correlation of Vital Capacity and Certain Measurements of the Body, London: Cassell and Company, 1920, p. 3.

28 Dreyer, op. cit. (27), pp. 17–18.

29 Smith and Horrocks, op. cit. (25), p. 78.

30 Dreyer, op. cit. (27), p. 18.

31 Smith and Horrocks, op. cit. (25), p. 78.

32 Flack, Martin, ‘The Milroy Lectures on Respiratory Efficiency in Relation to Health and Disease’, The Lancet (1924), 198, pp. 693696.

33 For example, see Aslett, Edward, Hart, Phillip D'Arcy and McMichael, John, ‘The lung volume and its subdivisions in normal males’, Proceedings of the Royal Society of London, Series B, Biological Sciences (1939) 126(845), pp. 502528, 506.

34 Smith, Barbara Ellen, ‘Black lung: the social production of disease’, International Journal of Health Services (1981) 11(3), pp. 343–342, 346.

35 Smith and Horrocks, op. cit. (25), p. 75.

36 Moncrieff., AlanTests for respiratory efficiency’, The Lancet (1932) 220, pp. 665669, 665–666.

37 Ministry of Pensions. HC Deb, 19 March 1917, vol. 91, cc1588–1694 (1602), at http://hansard.millbanksystems.com/commons/1917/mar/19/ministry-of-pensions#S5CV0091P0_19170319_HOC_287.

38 Anderson, Julie, War, Disability and Rehabilitation in Britain, Manchester: Manchester University Press, 2011, pp. 4243.

39 Anderson, op. cit. (38), p. 42.

40 Coreen McGuire, ‘The “deaf subscriber” and the shaping of the British Post Office's amplified telephones 1911–1939’, PhD thesis, University of Leeds, 2016, p. 48.

41 Perry, Heather, Recycling the Disabled: Army, Medicine and Modernity in WW1 Germany, Manchester: University of Manchester Press, 2014, p. 11.

42 Perry, op. cit. (41), p. 63.

43 The phrase ‘will to standardize’ is Timmermans and Berg's, and they use it in reference to the ‘gold standard’ in healthcare. See Timmermans, Stefan and Berg, Marc, The Gold Standard: The Challenge of Evidence-Based Medicine and Standardization in Health Care, Philadelphia: Temple University Press, 2003. For a discussion of the MRC's standardized assessment of Alzheimer's disease diagnosis see Wilson, Daniel, ‘Calculable people? Standardising assessment guidelines for Alzheimer's disease in 1980s Britain’, Medical History (2017) 61(4), pp. 500525. For a discussion of the standardization of audiometric testing within the MRC see Virdi, Jaipreet and McGuire, Coreen, ‘Phyllis M. Tookey Kerridge and the science of audiometric standardization in Britain’, BJHS (2018) 51(1), pp. 123146. Michael Worboys points out that the MRC invented a new ‘MRC scale’ instead of using the HRSD or Hamilton scale in their study of depression between 1964 and 1965, which supports the claim that the organization values standardized scales. See Worboys, Michael, ‘The Hamilton rating scale for depression: the making of a “gold standard” and the unmaking of a chronic illness, 1960–1980’, Chronic Illness (2012) 9(3), pp. 202219, 210.

44 Cayet, Thomas, Rosental, Paul-Andre and Thebaud-Sorger, Marie, ‘How international organisations compete: occupational safety and health at the ILO – a diplomacy of expertise’, Journal of Modern European History (2009) 7(2), pp. 174196, 177.

45 Timmermans and Berg, op. cit. (43), p. 22.

46 Sumner, James and Gooday, Graeme J.N., ‘Introduction: does standardization make things standard?’, History of Technology (2008) 28, pp. 113. For example, a British person driving would not notice that the designs of cars, roads, roundabouts, signage and so forth are all embedded and constructed to conform with the arbitrary standard of agreed driving on the left, but these standards become very visible when attempting to drive in the US.

47 Clarke, Adele E., Shim, Janet K., Mamo, Laura, Fosket, Jennifer Ruth and Fishman, Jennifer R., ‘Biomedicalization: technoscientific transformations of health, illness, and U.S. biomedicine’, American Sociological Association (2003) 68(2), pp. 161194, 174.

48 Gilson, John C. and Hugh-Jones, Phillip, Lung Function in Coalworkers’ Pneumoconiosis, Medical Research Council special report series no 290, London: Her Majesty's Stationery Office, 1955, p. 132.

49 For a comparative study which makes the point that easily quantified measurements have historically been prioritized in electricity see Gooday, Graeme, The Morals of Measurement: Accuracy, Irony, and Trust in Late Victorian Electrical Practice Cambridge: Cambridge University Press, 2004.

50 Macnaughton and Carel, op. cit. (5).

51 Faull, Olivia K., Hayen, Anja and Pattinson, Kyle T.S., ‘Breathlessness and the body: neuroimaging clues for the inferential leap’, Cortex (2017) 95, pp. 211221.

52 Edgar King to Fred Swift, 20 November 1923, SMA, DM 443, Box 6.

53 King to Swift, op. cit. (52).

54 Melling, op. cit. (8).

55 Melling, op. cit. (8), 427.

56 Oxley, Rebecca and Macnaughton, Jane, ‘Inspiring change: humanities and social science insights into the experience and management of breathlessness’, Current Opinion in Supportive & Palliative Care (2017) 10(3), pp. 256261, 257.

57 Oxley and Macnaughton, op. cit. (56), p. 257.

58 Bourke, Joanna, The Story of Pain: From Prayer to Painkillers, Oxford: Oxford University Press, 2014, p. 84.

59 Bourke, op. cit. (58), p. 87.

60 Bloor, op. cit. (8), p. 129.

61 Bloor, op. cit. (8), p. 129.

62 Melling, op. cit. (8), 428.

63 This expression is attributed to an address on ‘The effects of dust inhalation in mines’ that J.S. Haldane delivered to the South Wales Institute of Engineers in 1923 and is quoted in Cotes, John E., ‘The Medical Research Council Pneumoconiosis Research Unit, 1945–1985: a short history and tribute’, History of Occupational Medicine (2000) 50(6), pp. 440449, 440. For a more thorough discussion of this remark in the context of the 1930 controversy about miners’ silicosis see Meiklejohn, Andrew, ‘History of lung diseases of coal miners in Great Britain: Part 3, 1930–1952’, British Journal of Industrial Medicine (1952) 9, pp. 208220, 211.

64 Interview of D.C. Davies, 1930–1976 transcript reference no AUD 387, accessed at South Wales Miners Library (SWML), p. 2. The theory was that the irritation in the lungs would cause the men to spit up the silicosis dust.

65 Perchard, Andrew and Gildart, Keith, ‘“Buying brains and experts”: British coal owners. Regulatory capture and miners’ health’, Labor History (2015) 56(4), pp. 459480, 464.

66 ‘Stuttering’ is aptly used in Melling, op. cit. (8), p. 430.

67 Perchard and Gildart, op. cit. (65), p. 462.

68 McIvor, Arthur, ‘Miners, silica and disability: the bi-national interplay between South Africa and the United Kingdom, c.1900–1930s’, American Journal of Industrial Medicine (2015) 5, pp. 523530, 525.

69 Bufton, Mark and Melling, Joseph, ‘“A mere matter of rock”: organised labour, scientific evidence and British government schemes for compensation of silicosis and pneumoconiosis among coalminers, 1926–1940’, Medical History (2005) 49, pp. 155178, 157.

70 Bloor, op. cit. (8), p. 129.

71 See Bufton and Melling, op. cit. (69), p. 162; McIvor, op. cit. (68), p. 526.

72 McIvor, op. cit. (68), p. 525.

73 Braun, op. cit. (19), p. 143.

74 McIvor, op. cit. (68), p. 528.

75 The Silicosis Medical Board in Wales was based in Cardiff. See Dr Gwent Jones, draft report, ‘A survey on silicosis in Wales’ (1943), accessed at the Richard Burton Archives, Swansea University, reference no SWCC: MNC/PP/15/1, p. 19.

76 Braun, op. cit. (19), p. 144.

77 Report by the committee, Council, Medical Research, special report series no 243, Chronic Pulmonary Disease in South Wales Coalminers, London: His Majesty's Stationery Office, 1942, introduction, p. ix, accessed at the National Archives, FD 41243 (not public record, status open), National Archives, FD 41243.

78 Bufton, Mark and Melling, Joseph, ‘Coming up for air: experts, employers, and workers in campaigns to compensate silicosis sufferers in Britain, 1918–1939’, Social History of Medicine (2005) 18(1), pp. 6386, 75.

79 Bufton and Melling, op. cit. (69), p. 161.

80 ‘Report of court of appeal decision upholding employers appeal against compensation award’, the National Archives, in Various Industries Scheme – Extension to Coal Mines 1934, pin. 12/72.

81 Newspaper clipping, ‘Appeals against compensation won. Employers’ protection under silicosis scheme’, the National Archives, in Various Industries Scheme –  Extension to Coal Mines 1934, pin. 12/72.

82 Bufton and Melling, op. cit. (69), p. 164.

83 Bufton and Melling, op. cit. (69), p. 167.

84 Braun, op. cit. (19), p. 143.

85 MRC, op. cit. (77), p. vi.

86 Hart, Phillip D'Arcy, ‘Chronic pulmonary disease in South Wales coal mines: an eye-witness account of the MRC surveys (1937–1942)’, Society for the Social History of Medicine (1998) 11, pp. 459468, 462.

87 MRC, op. cit. (77), p. v.

88 Valier, Helen and Timmermann, Carsten, ‘Clinical trials and the reorganization of medical research in post-Second World War Britain’, Medical History (2008) 52, pp. 493510.

89 D'Arcy Hart, op. cit. (86), p. 462; see also MRC, op. cit. (77), which states that the medical survey was undertaken by D'Arcy Hart and Aslett with contributions from Hicks and Yates and that the pathological report was made by T.H. Belt with assistance from A.A. Ferris.

90 D'Arcy Hart, op. cit. (86), p. 462.

91 Preface to MRC, op. cit. (77).

92 See MRC, op. cit. (77), Medical Survey, p. 35, and preface p. vii.

93 The four categories were scaled from ‘no, or only slight, respiratory embarrassment’ to ‘breathless at rest’ and included intermediate points. MRC, op. cit. (77), p. 47.

94 MRC, op. cit. (77), p. 47.

95 It is worth noting that these categories are described as ‘convenient’ and there were some initial restrictions of this compensation. See ‘Summary of Chapter 5’ in MRC, op. cit. (77), introduction, p. v.

96 Braun, op. cit. (19), p. 145.

97 Jones, op. cit. (75), p. 12.

98 Braun, op. cit. (19), p. 145.

99 Bloor, op. cit. (8).

100 Braun, op. cit. (19), p. 146.

101 MRC, op. cit. (77), p. 143.

102 MRC, op. cit. (77), Medical Survey (ii), incidence of X-ray changes in different mining occupations, p. 168, original emphasis.

103 Jones, op. cit. (75), p. 17.

104 Turner, David and Blackie, Daniel, Disability in the Industrial Revolution: Physical Impairment in British Coalmining, 1780–1880, Manchester: Manchester University Press, 2018.

105 Jones, op. cit. (75), p. 17.

106 Braun, op. cit. (19), p. 144.

107 Melling, op. cit. (8), pp. 446–448.

108 Braun, op. cit. (19), p. 143.

109 Gilson and Hugh-Jones, op. cit. (48), p. 27.

110 Aslett, D'Arcy Hart and McMichael, op. cit. (33), p. 504.

111 Smith, op. cit. (34), pp. 347–348.

112 Gilson and Hugh-Jones, op. cit. (48), p. 27.

113 Gilson and Hugh-Jones, op. cit. (48), p. 27.

114 Braun, op. cit. (19), p. 160.

115 MRC, op. cit. (77), p. 111.

116 Aslett, D'Arcy Hart and McMichael, op. cit. (33), p. 505.

117 Braun, op. cit. (19), p. 162.

118 Braun, op. cit. (19), pp. 160, 164.

119 Porter, op. cit. (23).

120 Lorraine J. Daston and Peter Gallison, Objectivity, New York: Zone Books, 2007, p. 34.

121 Haslanger, Sally, ‘Epistemic objectification and oppression’, in Kidd, Ian James, Medina, Jose and Pohlhaus, Gaile Jr (eds.), The Routledge Handbook of Epistemic Injustice, Oxford: Routledge, 2017, pp. 279290, 284.

This work was supported by the Wellcome Trust (grant no 103339) as part of the Life of Breath project. I would like to thank the Life of Breath team for their helpful comments on the presentation of this work. I am further indebted to Havi Carel, Graeme Gooday and Richard Bellis for their vital criticism and editorial remarks on earlier drafts. Special thanks to Lundy Braun for discussing her research on historical spirometry at the University of Bristol in March 2018. I am also grateful to Marie Thebaud-Sorger, Stephen Mawdsley, Sally Horrocks, Charlotte Sleigh and the two anonymous referees for their assistance with this work.

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