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A miner triumph of diagnosis

I asked my patient to take his shirt off, so I could examine his chest. So he did.

‘Wow…’ I said, my voice loaded with admiration. ‘Can I touch it?’

‘If you like, lad,’ he said, so I ran my fingers over the finest coal tattoo I’d ever seen.

I realise at this point that I’m going to have to explain what a coal tattoo is; most of the younger generation of GPs will never have seen one. If you worked down a mine before about 1960, you’d be bare chested and sweating, and given the nature of the job at the time, it was not entirely unlikely that a ton of rock might fall on you at some point. This might rip the skin from your back, and assuming you were lucky enough to survive and heal up, the coal dust under your skin would give you a permanent reminder of your travails. This one was a roughly twelve-inch square of sub-epidermal carbon.

I can’t remember the last time I saw a coal tattoo. I can remember the first time. My grandad used to sit in a tin bath in front of the fire after his shift at Blackhall Colliery and I remember a reasonable specimen of a coal tattoo on his shoulder. I apologise for the overtly ‘Hovis’ nature of that reminiscence, but as it’s true, I won’t retract it.

Anyway, my patient’s more impressive example caused me to reflect on occupational illnesses. We don’t get them any more and I sort of miss them. It’s not that I want people to die of their jobs like they used to, but I have a yearning for the days when Sherlock Holmes could identify, by the callus on his index finger, a man who blocked hats for a living. Whatever that means.

Chimney sweeps, for goodness sake, used to have their own illnesses. I met a chimney sweep quite recently (and I absolutely loved his business card; not only would he sweep your chim-chiminey but he’d also turn up at your wedding, for a fee, to kiss everyone for good luck) but the chances of him having Pott’s tumour of the scrotum (a chimney-sweep disease) are remote these days.

Our pneumoconiosis and asbestosis sufferers are pretty much all gone. I never really believed in the teachers who used to suffer from the chalk disease (I never met any of them).

So what occupational diseases do we have left, other than repetitive strain injury from keyboards?

Today I met one: ‘Got this pain in my elbow. Couple of months now. Right there,’ he said, pointing at his lateral epicondyle. I had a brief prod, and then gave him the lowdown.

‘That’s tennis elbow,’ I told him. ‘Do you, by any chance, play tennis?’ I was not hopeful. In 20 years of general practice, I have never met a sufferer of tennis elbow who has ever played tennis, or of golfer’s elbow who ever played golf.

‘Actually doctor, I’m a tennis coach.’ I was tempted to get up and do an elaborate tribal dance, but I restrained myself. ‘I’m actually quite pleased to have spotted that,’ I said.

He was pleased as well. ‘Well I’ve learned something today,’ he told me. ‘What’s that?’ I asked. ‘A tennis coach can get tennis elbow in his other arm.’ ‘You don’t use that arm for tennis?’ I asked him. ‘Nope. Left-handed.’

Back to the bloody drawing board, it seems.