FLETCHER C M
Calif Med. 1958 Jan;88(1):1-11.
In the program of research into the natural history of coalworkers' pneumoconiosis now being carried out in Great Britain, emphasis is being put upon the importance of sharpening and validating means for early diagnosis, and upon the need for follow-up studies upon properly selected population samples. Existing information from morbidity and mortality figures from chronic bronchitis and emphysema in Great Britain suggests that atmosphere pollutants are important etiological factors. A parallel is drawn between the course of events in pneumoconiosis, in which dust retention in the lungs does not greatly disable until complicated by tuberculous infection, and a hypothesis that bronchitis is a hypersecretion of bronchial mucus caused by atmospheric irritants and does not disable but encourages secondary infection which may cause emphysema. This hypothesis requires testing by follow-up studies of population samples exposed to various environmental influences. It is suggested that in order to bring this common and disabling disease under control, clinicians must widen their interests beyond the confines of the hospital walls.
目前在英国开展的煤矿工人尘肺自然病史研究项目中，重点强调了强化和验证早期诊断方法的重要性，以及对适当选取的人群样本进行随访研究的必要性。来自英国慢性支气管炎和肺气肿发病率及死亡率的现有信息表明，大气污染物是重要的病因因素。尘肺的病程是肺部积尘在并发结核感染之前不会造成严重损害，由此引出一个假说，即支气管炎是由大气刺激物引起的支气管黏液分泌过多，它本身不会造成损害，但会引发继发性感染，而继发性感染可能导致肺气肿。这一假说需要通过对受各种环境影响的人群样本进行随访研究来加以验证。有人提出，为了控制这种常见且使人丧失劳动能力的疾病，临床医生必须将兴趣扩展到医院围墙之外。
