Population-based Research in South Wales: The MRC Pneumoconiosis Research Unit and the MRC Epidemiology Unit: Wellcome Witnesses to Twentieth Century Medicine: Vol 13
Authors: D. Sharp
Journal: Journal of the Royal Society of Medicine (2003)

A slate museum near Llanberis displays a letter, written to a newspaper in 1922, in which the medical officer at Penrhyn Quarry asserts that the dust his miners are exposed to is ‘not merely harmless but beneficial’. Had he been in South Wales, where coal ruled, Dr J Bradley Hughes would not have been so bold. Even when compensation for coalminers' lung disease was introduced in 1929, it required proof of work with hard rock. Other occupationally affected coalminers were unhappy at being excluded. This medical problem, made politically urgent by the threat of war, was taken on by the Medical Research Council, together with a hypothesis on a compounding role for tuberculosis and evidence that X-ray changes were more frequent as the coal type moved from bituminous in the eastern South Wales coalfield to anthracite in the west.

MRC activities in South Wales are now the stuff of history. So in a way is pneumoconiosis. When the first MRC unit was set up in 1945, the UK had 800 000 coalminers, 15% of them in South Wales; and of the country's 20 000 certified cases of pneumoconiosis most were in the Welsh coalfields. Those coal communities were devastated by the market-force economics of the 1980s, but long before then there had been diversification of MRC-backed research in South Wales. The MRC Epidemiology (Research) Unit was set up in 1960. It closed in 1999.

The Wellcome Witnesses to Twentieth Century Medicine programme captures, via interviews and a seminar, the recollections of men and women who ‘were there’. This is living or oral history. The 1994 seminar on the pneumoconiosis years was never published in full because the illness of the unit's first director, Charles Fletcher, made interviewing incomplete. Perhaps it is the transplantation of material from that earlier exercise or simply my unfamiliarity with these Wellcome history projects that is to blame, but presentation of the 1999 seminar, interviews, and other recollections about the epidemiology unit is confusingly fragmented.

Today's readers and tomorrow's archive-diggers will have different expectations but I would single out two key living issues for population epidemiology. How did the South Wales studies achieve such high participation rates and what are the pros and cons of having a research unit embedded within the community under study, perhaps a bit detached from the more traditional academic environment? The decision not to interview miners or other study participants seems a mistake if we are interested in exactly how percentage response rates in the very high 90s were achieved (journal editors sometimes assert that anything less than 80% is unpublishable, though this rule tends to get bent). Where exactly lay the balance between the industry, patience and ingenuity of the fieldworkers, amply illustrated in this book, and the commitment of the people of the valleys to these projects? Nor, despite prodding by the seminar's chairman, Sir Richard Doll, do we learn much about MRC thinking behind appointments and administrative matters that might have thrown light on the second question. A contribution selected by the editors as especially revealing—Peter Sweetnam's entertaining description of the life of a statistician before the computer era—mirrors contemporaneous MRC-backed analyses of DNA crystallographic data, which were just as laborious. We also learn that early medical staff members ate bread and jam without butter; that the late Archie Cochrane was not perfect; and that no-one is sure whether or how often or indeed why miners were given half-crowns to take part.

By the time the epidemiology unit closed, its reputation was being built on studies and on populations different from the occupational or respiratory and coalmining. Best known perhaps are the aspirin trials on the prevention of fatal acute myocardial infarction (1974 and 1979), the Caerphilly studies and the hint from 1979 that wine is good for you. And the work continues, an example from February 2003 being a paper on shaving and cardiovascular disease.

There was something special about the South Wales studies, and younger students are lucky to have this record of those times and a reminder that epidemiology is not just number-crunching but has a human face.