Behind the picture: Archie Cochrane and the Welsh coal miners
As The Cochrane Collaboration celebrates its 20th Anniversary, Isabel Baker delves into the MRC archive to look back on its pioneering namesake, Professor Archibald Leman Cochrane, and the story of this photograph, taken during his ambitious project to X-ray the entire population of a Welsh mining valley.
This photograph, taken at the Rock Colliery in Wales in 1953, is of the MRC Pneumoconiosis Research Unit X-raying team. The team look pretty happy considering their gruelling schedule, working long unsociable hours in a marquee and X-ray van set up at the pithead.
Between 1950 and 1953 the PRU team X-rayed all of the coal miners and ex-miners in the Rhondda Fach deep coal mining valley in South Wales — no small undertaking given that the mining population of the valley was more than 6,000. Another team, from the Welsh Regional Hospital Board, X-rayed the women, children of school age, and non-mining men.
The unit was based at Llandough Hospital in Penarth in South Wales, and was set up in 1945 to research the problem of coal workers’ ‘black lung’, or pneumoconiosis, which caused more than 22,000 British miners to leave work between 1931 and 1948.
Archie (seated far left in the photo) joined the unit in 1949 with a strong interest in respiratory diseases, especially tuberculosis, and big plans in mind. It had been suggested that a complication of pneumoconiosis called progressive massive fibrosis might be tuberculosis modified by dust, so he set out to identify TB by X-ray and reduce cases in the valley to see what effect this would have on rates of progressive massive fibrosis.
The X-ray measurements were combined with sputum measurements (mucus from the lower airway) from each person, to identify as many cases of tuberculosis as possible, and admit them to hospital.
The team’s ‘Rock Now X-Raying’ board was just one of their ways to encourage the miners to be X-rayed, though according to the field team, the offer of transport to the clinic in Archie’s Jaguar was a powerful persuasion. They also promoted the survey via radio, television, lectures and posters. And when half the names were crossed off the lists, members of the team went to visit everyone who hadn’t been X-rayed.
Despite this challenging proposition, with MRC funding Archie managed to obtain a remarkable 98 per cent cooperation rate in miners, as well as 95 per cent of the whole Rhondda population, in 1950-51. The introduction of antibiotics around 1945 meant that tuberculosis rates reduced dramatically, and the outcome of the survey was never clear. Archie then concentrated his meticulous approach on making measurable estimates of the relationship between dust exposure and pneumoconiosis.
The idea of accumulating and analysing evidence may seem obvious to us now. But it hadn’t always been obvious to the medical profession. Archie proposed this radical new idea — and showed that he was prepared to put the work in to support it.
The Cochrane Collaboration is a not-for-profit organisation that gathers the best available scientific evidence about interventions and shares the findings with practitioners, governments and the public. It was established in 1993, inspired by Archie’s call for medicine to be evidence-based. Today, the Cochrane Controlled Trials Register has produced more than 5,000 systematic reviews and nearly 28,000 people in 120 countries participate in this work. You can watch a video about 20 years of the Cochrane on YouTube.
Archie Cochrane, father of evidence based medicine (including footage of the X-ray project)