How Silicosis and Coal Workers' Pneumoconiosis Develop – A Cellular Assessment

"A pneumoconiosis is best defined as the accumulation of dust in the lungs and the tissue's reaction to iu presence. Thus, silicosis is the name given to the fibrotic disease of the lungs caused by inhalation of dust containing silicon dioxide, primarily in the free crystalline form. Coal workers' pneumoconiosis (CWP), which was originally thought to be a variant of silicosis, results from inhalation of coal mine dust that usually contains relatively small amounts of free crystalline silica.HISTORYSilicosis is the older and more well known of these mineral pneumoconiosis. In contrast, CWP was not recognized as different from silicosis until the pivotal work of Collis and Gilchrist. 26 They noted that coal trimmers, i.e., special stevedores who leveled coal in the holds of ships at the Cardiff and Swansea docks in Wales, developed identical nodules on the chest radiograph to those of underground miners. The difference was that these men had never worked underground and that the coal was washed before it was loaded into ships; thus, it was unlikely that these men were exposed to silica. Gough54 examined the lungs of coal trimmers who died and found that the histologic appearance of the pulmonary lesions was distinctly different from the whorled nodules seen in silicosis. Gough,"" and subsequently Heppleston,"" then showed that the lung lesions in coal trimmers were similar to those in underground coal miners and different from those of classical silicosis. Nagelschmidt 78 analyzed the mineral content of miners' lungs that became available at autopsy. These studies caused him to propose a scheme in which the relative proportions of silica, other minerals, and/or coal deposited in the lungs determined the type of pulmonary response which develops, i.e., classical silicosis, mixed-dust disease, or CWP."