I went to see William Jenkins when I was a medical student based in Ashgrove Surgery, Pontypridd.
Mr Jenkins lived in Abercynon. He had lived there all his life, first with his parents and then, after he got married, in Tegwen Terrace with his wife, Mary. Both houses were close to the colliery. His father had worked there and, when he was sixteen years old, young Master Jenkins had started in the mine.
Mrs Jenkins opened the door almost as soon as I rang the bell.
‘Hallo, you must be Lois,’ she said. ‘Come in. It’s cold outside.’ I followed her down the hallway. ‘Bill’s in the sitting room. Come through.’ Mr Jenkins was in a high, straight-backed armchair to one side of the fireplace. He was a small, thin man. The chair dwarfed him. His hair was wiry and jet black. It was so black that it made his skin look pale.
He smiled at me. ‘Good afternoon, doctor. Sit down.’ He gestured to the chair facing his.
‘I’m just a student,’ I said, sitting down.
‘You’ll be a doctor soon. Look at Glynne Warren. He was here as a student a few years ago. Now, he’s working in the practice.’
‘I don’t know about that. I am beginning to think there’s too much to learn. Anyway, how are you?’
‘I’m alright. It’s just this breathing. You can see that for yourself.’
I watched him. He was breathing slightly more quickly than normal.
‘He can’t do much,’ Mrs Jenkins said.
‘I can still get up the stairs to go to bed.’
‘It takes him ages, doctor. He is so weak he has to pull himself up using both handrails. He stops twice on the way.’
‘Come on, Mary.’ Mr Jenkins said. ‘There’s no point in rushing around. You’re always in too much of a hurry.’
‘Luckily, we’ve got one toilet downstairs and one upstairs. We are having a stair lift fitted. It will make things easier.’
‘I don’t want a stair lift.’
Mrs Jenkins put her hands on her hips. ‘You’re having a stairlift, Bill. Dr Lane thinks you need a stairlift. Glenys, the nurse, thinks you need a stairlift and I think you need one.’
He lowered his eyes. ‘You’re ganging up on me.’
Mrs Jenkins ignored him. ‘Would you like a cup of tea, doctor? I have just made a fresh pot.’
‘Yes, please.’
She poured some tea for me. ‘It’s our best china,’ she said. ‘We don’t often use it. It’s nice to have a visitor.’
‘I prefer my tea in a mug,’ Mr Jenkins said.
‘How long has your breathing been bad?’ I asked him.
‘It’s been a lot worse since January. I had the flu then and got a chest infection. I haven’t really picked up.’
‘Your breathing was pretty bad before that, Bill.’
‘It was nowhere near as bad as it is now, Mary. I could walk down to the end of the terrace. I managed that up until Christmas.’
‘It’s a few hundred yards. That’s all.’ Mrs Jenkins pointed out.
‘I can only get as far as the front gate, now. I’ll go out there if the weather’s alright. I like to watch the people walking into the village. I still know most of them.’
‘He doesn’t like being stuck inside the house, doctor. He used to walk for miles. On his days off he would walk for a couple of hours.’
‘I used to like walking. I can’t do it anymore. This cough is a nuisance too. It’s persistent. I thought it would improve after I stopped working, but it hasn’t. I get terrible spasms of coughing at times.’ He sighed.
‘They’re awful, doctor. He can’t catch his breath when he gets those spasms. I keep thinking he’ll stop breathing altogether.’
‘I won’t stop breathing, Mary. I keep telling you that. I’m still coughing up black phlegm, doctor. There is not as much as there used to be. It makes me wonder what’s going on in my lungs.’ Mr Jenkins looked apprehensively at me. ‘Have you seen anyone’s lungs, anyone with pneumoconiosis? Have you seen a miner’s postmortem?’
‘I haven’t seen an actual postmortem. I’ve seen photographs of their lungs in books.’
‘Were they black?’
‘Yes, the ones that I’ve seen were black,’ I said. The coal dust seems to get everywhere.’
‘It’s not surprising, is it? I worked in that mine for over forty years. I was breathing in coal dust every day. I took it home on my clothes, on my skin, in my hair. I even ate coal dust: it went onto my sandwiches.’
‘You had your tin for your sandwiches, Bill.’
‘Yes, we all had our tins, but the dust still got onto the bread.’ Mr Jenkins paused. ‘I insisted on having an x-ray. That was in 1970. I felt that I was getting out of breath. To start with, they said I had minor changes. There were signs that coal dust had settled in the lungs, but they didn’t think it had caused any real damage.’
‘You were coughing, Bill.’
‘Virtually all miners cough, Mary. The dust makes you cough. Coughing helps get rid of those dust particles.’
‘I think the pneumoconiosis had started by then,’ Mrs Jenkins said. ‘They should have stopped you working.’
‘We couldn’t afford it, Mary.’
‘Well, I think they should have stopped you, Bill. We could have made do with our savings and my job.’
Mr Jenkins shook his head. ‘We’d never have managed. Anyway, I had an x-ray every year after that. It was three years later when they said I had the nodules. They said that some of them were large, over an inch in size. They could see scarring in the lungs close to the nodules as well. They showed me the x-ray. I couldn’t really make head or tail of it.’
‘That’s when they admitted that he had the pneumoconiosis, doctor.’ Mrs Jenkins spoke quietly.
‘Pneumoconiosis is the proper medical name,’ Mr Jenkins said. ‘We all called it black lung disease, in the mines. I was getting more breathless by then. I was coughing up black phlegm every day. They advised me to stop working. That was five years ago.’
‘Since then, he’s got gradually worse.’
‘I was lucky, wasn’t I, Mary? Harry Booth was diagnosed at the same time as me and he died two years later.’
‘Harry was such a nice man, Bill. I really liked him.’
‘His chest deteriorated quickly. They said it was because he had been a smoker. His back went as well, with all that crouching in the mines. He had an dreadful stoop.’
‘It was sad to see him, Bill,’ Mrs Jenkins said. ‘He turned into an old man in front of our eyes.’
‘There was Alf Eldridge.’
‘Yes, poor Alf. He died very quickly. Elsie had been looking forward to his retirement but, before she knew it, she was a widow.’
‘He had never smoked, Mary.’
‘No, he hadn’t. I will always say it’s the coal more than the smoking that causes this pneumoconiosis.’
‘I think you’re right there.’ Mr Jenkins nodded his head in agreement.
‘There were accidents weren’t there, Bill. Thank God you never had a serious accident!’
‘A lot of miners were injured or killed in accidents, doctor. Young people died, sometimes children. I lost a few close friends.’
‘Show her your scar, Bill.’
‘She’s seen it.’ I had already noticed the scar, but Bill turned his head to give me a better view. There was a large, irregular patch of pale, thickened scar tissue around his left temple. There were bluish, black streaks of coal in it. ‘You never get rid of the cold dust in the scars,’ he said. He laughed and held his arms out. The backs of his hands and his arms were peppered with dark scars. ‘They’re coal tattoos,’ he said. ‘You only needed a scratch, or a tiny cut and the coal would get in.’
‘What happened to your head?’ I asked.
‘It was a roof fall. We were close to the coal face. A load of stones and dirt came down. A big stone hit me. John Gardener was knocked out and buried but we got him out quickly. John had fractured his skull. He made a good recovery but developed epileptic fits and had to give up work. There was another roof fall two weeks later. Huw Jones was hit by a huge rock. I reckon it weighed half a ton. It killed him outright. Most fatal accidents were caused by roof falls.’
‘Tell her about Terry Bevan,’ Mrs Jenkins said.
‘That must have been the worst thing I saw in the mines. Terry and I were best friends. We went to school together. He was a good lad, a hard worker. On the day his accident happened, I think he was tired. It was near the end of a long, busy shift. He got his arm caught in the conveyer belt. You wouldn’t think it could do it, but it tore his arm off, just above the elbow. We couldn’t stop the bleeding. He had severed the main artery. By the time we got him up to the surface and the ambulance arrived he was dead.’
‘Terry was only forty-five at the time,’ Mrs Jenkins added. ‘He had three children. The eldest two worked in the mine.’
‘We were fortunate, though, here,’ Mr Jenkins continued. ‘People died and there were other severe injuries, but we never had any big explosions. We all dreaded explosions. I think most of us thought about the possibility every time we went down into the mine. There was a sense of relief when you finished your shift and came out into the fresh air. You’d survived another day.’ He paused to take a few breaths. He coughed.
‘All the wives were terrified of an explosion, doctor, all of us. Sometimes, I couldn’t sleep worrying about it.’
‘Most explosions were caused by firedamp,’ Mr Jenkins said. ‘It’s a mixture of methane and other gases. There are pockets of methane underground. If there is enough methane in a mine tunnel, it doesn’t take much to set it off. In the years before we had safety lamps, explosions were usually caused by candles or oil lamps. An explosion can be ignited by a spark from an electrical fault or from cutting the coal with a pick. Cigarettes were another possible cause. They were illegal, but some of the miners smuggled cigarettes and matches in.’ Mr Jenkins coughed again.
‘You’re talking too much, Bill. He always does when there’s a student.’
‘I’m fine, Mary,’ he continued. ‘The mine tunnels are full of coal dust, of course. The heat of an explosion can set the dust alight and the fire will rage through the tunnels. It’s like being in a furnace. In an explosion, most miners will be killed by the effects of the blast itself or by burns from the flames. Others are suffocated by the carbon monoxide that’s produced.’
‘Do you remember The Six Bells explosion, Bill.’
‘How could I forget it, Mary?’ Mr Jenkins glanced up at me. ‘The Six Bells mine was near Newport, not that far from here. There was an explosion there in 1960. It was probably one of the last big explosions in South Wales. Forty-five miners were killed. It was a methane explosion. They weren’t sure what set it off. They thought it could have been an electrical spark. The flames travelled nearly two miles underground.’
‘I can’t bear to think about those explosions, Bill. The poor miners!’ Mrs Jenkins shuddered. ‘The families would gather around the lifts for hours, waiting for the bodies to be brought up.’ She went through to the kitchen.
‘Would you like to listen to my lungs, doctor?’
‘Yes, please.’ I got my stethoscope out. He pulled his shirt up and I listened carefully to the back and the front of his chest.
‘How does it sound?’
I hesitated. ‘There’s not a lot to hear, really.’
That’s good news, Mary.’ Mr Jenkins called to his wife. ‘The new doctor says that my chest is clear. I’m going to be alright after all.’ He grinned.
I blushed. ‘No, obviously, your lungs are pretty bad. Coal workers pneumoconiosis shows up best on the x-rays. You can’t hear much with the stethoscope. There aren’t any crackles or anything.’
‘He’s pulling your leg, doctor.’ Mrs Jenkins reassured me as she came back.
‘I know that my lungs are bad,’ Mr Jenkins said. Last time Dr Lane saw me, he said that I wasn’t quite ready for oxygen. That will be the next step. Apparently, there’s nothing else they can do.’
‘You’ve got your inhalers, Bill.’
‘They don’t help much, Mary. Dr Lane said that himself. Basically, my lungs are very badly scarred.’
‘You can’t get rid of the scarring once it’s there,’ I said.
‘Dr Lane said exactly the same.’ Mr Jenkins looked up at me. ‘How long have I got then, doctor?’
‘I blushed again. I… I…’
‘That’s unfair, Bill!’ Mrs Jenkins complained. ‘Dr Lane told you that it’s very difficult to predict these things.’
‘He didn’t want to tell me the bad news. That’s all it was.’
‘No, it wasn’t, Bill. He couldn’t tell you, not with any certainty.’ Mrs Jenkins frowned. ‘He’s written his will, doctor. We both have.’
I nodded.
‘We want to work out the funeral arrangements, next, Mr Jenkins said. I don’t want to leave everything for Mary to organise.’
‘I don’t mind, Bill.’
‘No. We’ll sort it all out in advance. I can’t decide whether I want to be buried or cremated, doctor. That’s a predicament for a miner.’ Mr Jenkins looked at me. ‘I don’t want to end up underground again.’
‘You told me that you wanted to be cremated, Bill.’
‘That depends on Mervyn. I’ve asked him for a discount. Everyone knows that coal miners’ bodies burn very efficiently. We’ll see what he says.’
Mrs Jenkins shook her head. She started clearing the cups and saucers.
COAL WORKER’S PNEUMOCONIOSIS (BLACK LUNG DISEASE)
In the nineteenth century and the first half of the twentieth century, coal mining was one of the most important industries in South Wales. At its peak, mining employed over 250,000 in Wales. It was dangerous work. Many miners were injured or killed in accidents. Others developed long-term health problems. Lung disease was relatively common.
In 1956, the British Journal of Industrial Medicine published a study [1] carried out through the Medical Research Council’s Pneumoconiosis Research Unit. This demonstrated that, in a selection of neighbouring mines in the valleys of South Wales, around 50% of miners over the age of 50 years had radiological evidence of pneumoconiosis, and about 20% had evidence of its most severe form, progressive massive fibrosis.
In coal workers, inhaled dust accumulates in the lungs over many years. The dust activates the immune system and causes the production of scar tissue. The scar tissue is fibrous and thicker than normal lung tissue. In a proportion of patients, this process of fibrosis continues to progress. Areas of normal lung tissue are replaced by scar tissue and large fibrous lumps form. Nearby alveoli (air sacs) and small airways are damaged and can no longer function properly. The fibrous, scar tissue does not have the same elasticity as normal lung tissue, and the lungs do not expand or contract properly. Our ability to breathe in is restricted.
Patients with coal workers’ pneumoconiosis usually develop a cough and difficulty breathing. They may cough up black sputum. Not all patients deteriorate, but those that do, become progressively more breathless. They eventually develop respiratory failure and die.
At the moment, there is no treatment that has been shown to reduce or reverse the fibrotic process. These days, lung transplant is an option for some severely affected patients.
REFERENCES
- CHAPMAN PJ, COCHRANE AL, DAVIES I, RAE S. The prevalence of coalworkers’ pneumoconiosis: its measurement and significance. Br J Ind Med. 1956;13(4):231-250. doi:10.1136/oem.13.4.231