Parkes' Occupational Lung Disorders

Anthony Newman Taylor, Paul Cullinan, Paul Blanc, Anthony Pickering, Anthony Newman Taylor, Paul Cullinan, Paul Blanc, Anthony Pickering

• Publisher: CRC Press
• Year: 2016
• ISBN:
  9781498715805
• Edition: 4
• Topic: Medicine
• Subtopic: Pulmonary & Thoracic Medicine

This authoritative text on occupational lung disorders builds upon the fundamentals, including clinical, epidemiological, and predictive approaches. It discusses interstitial and malignant diseases, airways diseases, and other respiratory issues, such as diving, working at high altitudes, and abnormal sleep conditions. It also covers related long-term conditions, such as asthma and COPD. This edition has been completely revised and brought up to date for all physicians dealing with pulmonary disorders caused by the environment or the workplace.

Print Versions of this book also include access to the ebook version.

1	The History of Occupational Lung Diseases
	A Long View
	Paul-André Rosental

CONTENTS

The Slow Emergence and Contested Role of the ‘Work Environment’

The Dust Century (Mid-Nineteenth to Mid-Twentieth Century)

Challenging Invisibility (Mid-Twentieth Century Onwards)

References

Occupational lung diseases have been a scourge whose history is as old as that of human labour, to the point that in 1915 the great industrial hygienist Edgar Collis wondered—no doubt wrongly—whether even cavemen had suffered from the most infamous of such diseases, namely silicosis. In the mid-twentieth century, eminent physicians such as Luigi Carozzi (1880–1963), the director of the International Labour Office’s industrial hygiene section, and George Rosen (1910–1977), a Yale University medical historian, undertook projects to identify references to these diseases in old medical texts (Carozzi, 1941–1942; Rosen, 1943; Meiklejohn, 1951–1952). Such references date back to antiquity, abounded in the seventeenth century and morphed into a dense scientific debate beginning in the nineteenth century, which was also the era of the Industrial Revolution.

The history of knowledge about these diseases is not one of cumulative and steady progress, however (Fleck, 1979). Over time, a number of theories that had been raised, such as the blood origin of the ‘black pigmentation’ of underground miners’ lungs or the pathogenic role of ‘miasma’, were later discarded, while the roles of dust, and later of radiation, were eventually aetiologically recognized. But clinicians ran into recurring problems; thus, while ‘nanoparticles’ have only been cited since the 1980s, the existence of pathogens too small to be observed had been suspected since the nineteenth century, and toxicological concepts pertaining to them were developed throughout the twentieth century (Oberdörster et al., 2007; Donaldson and Seaton, 2012).

Another obstacle, which was greater here than in other areas of medicine, was the major role that political, economic and social history played in the lifecycle of the diseases and the perceptions of doctors and workers themselves. Technological change constantly altered the hazards to which lungs were exposed. ‘Corporate’ medical systems run by employers (historically beginning with the mines) and, after the Industrial Revolution, public regulations, insurance and the struggle between labour movements and industry regarding the recognition of workplace hazards, all shaped the knowledge of occupational lung diseases, including their definitions and classifications. The importance of the non-medical context explains the endurance, particularly in the International Commission on Occupational Health’s (ICOH) Committee on the History of Prevention of Occupational and Environmental Diseases, of the tradition of ‘clinician–historians’, who delve into history as a means of contributing to current medical research (Blanc and Dolan, 2012).

THE SLOW EMERGENCE AND CONTESTED ROLE OF THE ‘WORK ENVIRONMENT’

Let us begin with medicine’s difficulty in recognizing lung diseases arising from dust, which continues to be an ongoing problem in the twenty-first century, in particular in emerging economies. For example, consider a Limoges porcelain workshop in central France in 1855, right before these diseases became prominent in industrial hygiene. Dr. Dépéret-Muret described ‘this fine and smooth dust covering the walls, the partitions, the boards, the machines and the work instruments with a thick coat that the slightest movement causes to spread through the air, enter the airways, and deposit on nasal, pharyngeal, laryngeal, and bronchial mucous membranes […]; to permeate clothes, deposit on the skin in a barely adherent layer, or become embedded in some areas like some kind of tattoo; finally, even to enter the digestive track with food, which is too often consumed in the workshops without taking proper measures of cleanliness beforehand; colic, dyspepsia, and diarrhoea ensue, creating yet another cause of nutritional deficiency and economic impoverishment’ (Dépéret-Muret, 1860, pp. 211–213). Dépéret-Muret, along with the porcelain workers themselves, saw dust as the cause of ‘coughing, dyspnoea and frequent recurrences of bronchitis, laryngitis, and pneumonia that more or less quickly but almost inevitably lead to tubercular phthisis’, especially in cases where ‘due to work requirements this inhalation is common, continual, and persistent’.

Yet, this doctor lamented at the time, ‘the impact of mineral dusts is still debated today’. Why has the medical field taken so long to agree on their importance? Rather than attacking the irrationality of past scientists, answering this question involves understanding the history of their observational methods, their reasoning and their own working conditions. This historical analysis will reconcile a number of considerations that, at first glance, might seem contradictory.

Risks linked to professional activity have long and variously been commented on. In antiquity, such commentaries came from doctors such as Hippocrates, Celsus and Dioscorides, as well as polymath non-clinician observers such as Teophrastus and Pliny the Elder, and even anonymous texts such as the Satire of Trades from the Egyptian papyrus Sallier II. Several points of convergence can be detected in this body of work. From antiquity through to the early modern period, both in Europe and elsewhere (Thomann, 2009), while authors made myriad comments on craft trades (Figure 1.1), they also focused on mining activity, particularly gold, sulphur and mercury. Mining was also the domain par excellence of reports that associated it with despised slave labour or even with the world of demons, as was the case made by Agricola during the Renaissance and, still at the dawn of the eighteenth century, by Bernardino Ramazzini. These documents show the long history of certain symptoms such as asthma (Bueß and Lerner, 1956; Pepys and Bernstein, 1999), and of the effects of certain toxins such as mercury (Kobal and Grum, 2010; Menéndez-Navarro, 2011, pp. 47–59). Finally, they reveal, as in the case of Pliny the Elder’s Historia Naturalis, the attempts of affected workers to protect themselves from risk, in particular by wearing makeshift masks.

However, this retrospective coherence is partly misleading. It masks the great diversity of scientific frameworks in which these observations were made. In Greek and Roman medicine, and particularly in the Galenic tradition that predominated through the Renaissance, breathing did not have the vital function ascribed to it today: it was seen as an activity regulating the temperature of the pneuma, the vital breath animating the body that was sometimes identified with the soul (Worthen, 1970; Furley and Wilkie, 1984; Hirai, 2005). From this perspective, lung history underwent a revolution in the seventeenth century, with William Harvey’s (1578–1657) new theories on blood circulation (Frank, 1980; Gregory, 2001), and another one several decades later, when the medical field embraced new principles of mechanical physics exemplified by Robert Boyle’s air pump (Merton, 1952; Schaffer, 1989; Bertoloni Meli, 2008).

FIGURE 1.1 Architect, stoneworkers and masons building a castle in the fifteenth century. (Courtesy of Municipal Library, Bordeaux, Coll, Jean Vigne/Kharbine Tapabor.)

While it had been a subject of university studies beginning in the Middle Ages, medicine was not a self-contained discipline. In the sixteenth century, it was often inseparable from chemistry, which itself heterogeneously gathered data, ‘through accumulation of data by miners, alchemists, craftsmen, and by pharmaceutical application of drugs’ (Hellman 1955, p. 196). By today’s standards, the Saxon Georgius Agricola (1494–1555) was primarily a mineralogist, a geologist and a philologist: he aimed to reshape the ancient Greco–Roman terms that were used in the science of his day by integrating German terms handed down by oral tradition in mining communities across Central Europe where he practiced medicine (Halleux and Yans, 1990; Hannaway, 1992).^* At the same time, Paracelsus (1493–1541), an itinerant physician also with mining town experience, placed his observations in a framework combining alchemical and magical concepts with a form of Catholic enlightenment in response to the Protestant Reformation (Weeks, 1996; Webster, 2002). Paracelsus focused on the relationships between human beings and their mineral environment (Sigerist, 1996). The role he attributed to sulphur, mercury and saltpetre in place of the ‘four elements’ left little room for the issue of dust in his treatise on mountain diseases, Von der Bergsucht und anderen Bergkrankheiten, which is often cited as the first book-length work dedicated to occupational diseases.

A century and a half later, the same need to reposition medical knowledge in the context of its broader development was expressed by Bernardino Ramazzini, whose 1700 treatise (further expanded in 1713) on occupational diseases (as well as observations that have elements of ethnography) resonates with contemporary medical issues (Ramazzini, 1705; Sakula, 1983; Bisetti, 1988; Carnevale and Baldasseroni, 2000; Carnevale et al., 2009). His work is often considered, in retrospect, to be the modern foundation of occupational health as a distinct discipline. But to the contrary, Ramazzini’s work, which focused on workplaces as one of the ‘environments’ to which human health is subject, also could be used today to break down the division between occupational and environmental diseases (Camuffo et al., 2000; Riva and Cesana, 2010; Vincent, 2012). The discussion on the relative position of bodily and environmental explanations was not simply a matter of doctrine; it evolved in step with the observational techniques that became available at that time. With the increased use of autopsies in the early modern period, and later the anatomo-pathological observations in the nineteenth century (Foucault, 1973), the discovery of a ‘black pigment’ in lung tissues led some doctors to favour a completely endogenous pathogenesis for certain occupational diseases.^† From the end of the seventeenth century, when Richard Morton (1637–1698) proposed this interpretation, up until the 1860s, when it was abandoned, several pathways were proposed in order to explain the genesis of these melanotic diseases: tracheobronchial, intestinal, haematic and, finally, cellular. As many of these observations related to coalminers, the interpretation was that of a failure in the decarbonisation of the blood, which at the time was often seen as a key function of breathing. In the middle of the nineteenth century, the ‘internal’ thesis was reformulated in Germany by Rudolf Virchow (1821–1902), who adopted what we would call today a cytopathic approach.

Many doctors, especially in England, countered this with an ‘external’ explanation of such disease. While they were convinced of dust’s pathogenic role, they did not see it as the sole explanatory factor. From the seventeenth through to the nineteenth centuries, practitioners who had been closely observing various work-related environments (no longer only underground miners, but increasingly discrete trades such as stone-cutters, granite cutters, potters, slate-quarry workers, knappers, needle manufacturers and workers who sharpen knives, forks or sickles on abrasive rocks) considered more general environments, including, but not limited to, the workplace. These observers alternately or concomitantly blamed: poor postures constraining breathing; deplorable living conditions (housing, food and drink); exceedingly low or high temperatures; multiple toxic gases, vapours or smoke; excessive working hours; and night work. ‘Dust’ itself was hard to grasp as an entity, since it included, as it does today, a mix of very different components.

Many observations accumulated without referencing each other, or remained compartmentalized by country or sector of activity. The various respiratory diseases affecting the miners of deposits located in the hills of Central Europe were lumped together under a specific category: Bergsucht, or ‘mountain disease’. It was not until the end of the nineteenth century that the category was broken down in order to differentiate between pneumoconioses and, in the Schneeberg mines to the south of Dresden, occupational lung cancer. The cause of the latter—radiation from uranium—was not identified until well into the twentieth century (Greenberg and Selikoff, 1993; Piekarski and Morfeld, 1997; Proctor, 2012a). The various approaches were fragmented as well. In the absence of sufficient empirical knowledge, experiments by Claude Bernard and his students in the nineteenth century overestimated the ability of the lungs to expel dusts by simply making animals inhale dusts for very short periods of time (several days), a time period that did not bear any relationship to human working conditions. Despite all of these obstacles, Dépéret-Muret’s analysis of the mid-nineteenth century marked the dawn of a scholarly revolution: entry into the ‘dust century’.

THE DUST CENTURY (MID-NINETEENTH TO MID-TWENTIETH CENTURY)

In the nineteenth century, anatomical–pathological and experimental observations were able to explain the path and effect of dusts in the respiratory tract in increasingly precise detail. In 1838, the Englishman Thomas Stratton (1816–1886) used the term ‘anthracosis’ to refer to the disease he believed was caused by coal dust (Meiklejohn, 1959). The decade of the 1860s was particularly decisive. In 1867, Friedrich Albert von Zenker (1825–1898) noticed the red pigmentation of lungs exposed to iron particles; he named the disease ‘siderosis’ in a nod to the processes it shared with anthracosis, and placed these two affl...