The nature of the material forming the massive lesions in the lungs of coal workers has never been demonstrated. The concept that it was in fact massive fibrosis, implying that it consisted of collagen impregnated with coal dust, has been challenged only during the last ten years. It was agreed that the best chance of obtaining more definite information was from a combined study of the biochemical, pathological, ultrastructural, and immunological features of a number of lungs containing these lesions. Six cases which were found to contain suitable material were studied. The preliminary results obtained suggest that collagen is present in the capsule of these lesions but that at the centre it is replaced by another insoluble protein or proteins which is probably stabilized by some form of cross-linking. This protein complex accounts for one-third of the weight of the lesions, the remaining two-thirds consisting of approximately equal amounts of mineral dusts and calcium phosphate. Serum proteins were also observed but their association with the lesions has yet to be determined.
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