The Problem of Dust and the Emergence of Chronic Disease

While a host of investigators began to study particu­lar acute diseases caused by specific industrial tox­ins, the problem of dust in the closed environments of factories and mines galvanized the attention of the health community and work force.

In the first half of the twentieth century, labor and business focused mostly on silica dust, and though this diverted attention from the other dust diseases, it did lead to the formulation of general public poli­cies that were applicable to other chronic industrial diseases. Politicians, labor, management, insurance company representatives, physicians, and lawyers all raised questions of responsibility for risk in the new industrial workplaces.

The central questions of the debate were: What was an industrial disease? How could occupational and environmental diseases be distinguished? How should responsibility for risk be assigned? Should a worker be compensated for impairments or for loss of wages due to occupational diseases and disabilities? Should industry be held accountable for chronic ill­nesses whose symptoms appeared years and some­times decades after exposure? At what point in the progress of a disease should compensation be paid? Was diagnosis sufficient for compensation claims, or was inability to work the criterion? Who was to define inability to work - the employee, the govern­ment, the physician, or the company? In short, the questions and arguments addressed the problem of who defined what today we would call latency, time of onset, and the very process of disease.

Shortly after the Boer War, silicosis gained wider public notice, as English miners who had worked in the South African gold mines returned to Great Brit­ain. Oliver described the fate of “young miners in the bloom of health” who, after working in the gold fields for only a few years, “returned to Northumber­land and elsewhere broken in health.” Because of the hardness of the rock from which gold was ex­tracted, dry drilling and blasting created special haz­ards both for native workers and for their English overseers. In 1902 a British governmental commis­sion was appointed to study the nature and preva­lence of lung diseases in these mines. Investigators such as Edgar Collis, H. S. Haldane, and the Miners’ Phthisis Commission demonstrated clearly that vic­tims of “Rand Miners’ phthisis” were primarily suf­fering not from tuberculosis, but from silicosis. This was the first systematic study of the hazard of expo­sure to silica dust.

In the United States, the British findings were employed by Frederick L. Hoffman in his study The Mortality from Consumption in Dusty Trades (1908). It began with the observation that “no extended consideration [was required] to prove that human health was much influenced by the character of the air breathed and that its purity is a matter of very considerable sanitary and economic importance.”

The study built on the clinical evidence presented in the British material as well as on progressive so­cial analysis. But it was also significant because Hoff­man used statistical data drawn from insurance com­pany records and census materials from both Great Britain and the United States. Although the British (especially Thomas Oliver) had also used statistical and epidemiological data in their investigations, Hoffman was the first American to use such methods. In so doing he documented the prevalence and scope of industrially created lung diseases and also used the statistical materials for their implications about the work environment.

The dust hazards for metal miners and other work­ers had become sufficiently apparent that, in 1911, the U.S. Public Health Service and the Bureau of Mines were asked by the National Association for the Study of Tuberculosis to conduct a thorough in­vestigation of lung diseases of metal miners. In 1914 the two federal agencies initiated the first such epidemiological study in the tristate lead- and zinc- mining region of Missouri, Kansas, and Oklahoma. The study exposed the horrendous toll that metal dusts were taking on miners in the area and graphi­cally described the suffering that many of the min­ers experienced as the disease progressed: “If we can imagine a man with his chest bound with transpar­ent adhesive plaster, we can form a mental picture of how useless were the efforts at deep inhalation made by these patients” (Lanza 1917a).

In Europe, as well as in the United States, the intro­duction of power hammers, grinders, cutting instru­ments, and sand blasters at the turn of the century had exposed large numbers of industrial workers to massive quantities of fine silica dust, which could penetrate deeply into their lungs. By the time of the Great Depression, many of these workers had devel­oped symptoms of silicosis and, under the financial strains created by massive unemployment, began to bring their claims for disability benefits into the workers’ compensation and court systems of the in­dustrialized nations. Thus, silicosis emerged as a major political, social, and economic issue in the mid-1930s.

In the United States this produced a massive num­ber of lawsuits which ultimately led to the conven­ing of national conferences and the revision of work­ers’ compensation systems. In this process, the issue of chronic industrial disease was forced onto the agendas of the medical and public health communi­ties, and the debate began over responsibility for risk as well as over definitions of the technical and medical means of distinguishing and diagnosing chronic conditions. In the ensuing years the problem of noninfectious chronic diseases created by indus­trial work processes would become the centerpiece of industrial medicine.

Although the relationship of dust exposure to can­cer was noted by the 1930s, it was only during the 1950s and 1960s that the medical and public health communities acknowledged its significance and such investigators as Wilhelm Heuper, Harriet Hardy, Ir­ving Selikoff, and Lorin Kerr began to link exposure to dusts and toxins at the workplace to a variety of cancers. The investigations by Irving Selikoff of as­bestosis, mesothelioma, and lung cancer were par­ticularly effective in galvanizing popular and profes­sional attention; the widespread dispersal of asbestos throughout the general environment caused pro­found awareness of the dangers of industrial produc­tion to the nation’s health.

Occupational health was also a matter of concern for many social, labor, and political movements and this concern focused on industrial hazards. During the Progressive Era, for example, such unions as the Bakers’ and Confectioners’ Union, the International Ladies Garment Workers Union, and the Amalga­mated Clothing Workers joined middle-class reform groups such as the^ National Consumers’ League to press for reform of working conditions. During the 1920s, activist organizations like the Workers’ Health Bureau ^f America sought to aid labor unions in investigations of workplace hazards and joined painters, hatters, and petrochemical workers to demand reform of factory conditions. During the 1930s various unions within the Congress of Indus­trial Organizations used deplorable health and safety conditions as a focal point for organizing work­ers in heavy industry. In the next two decades, other unions, such as_ι the International Union of Mine, Mill and Smelter Workers, pressed for national legis­lation to protect their members from dust hazards. In the 1960s safety and health became major activi­ties for such unions as the Oil, Chemical and Atomic Workers’ Union (OCAW) and the United Mine Work­ers (UMW). Leaders like Lorin Kerr of the UMW and Anthony Mazzochi of the OCAW were involved in lobbying for national legislation to protect miners and other workers, and the UMW was also active in urging special legislation to compensate victims of coal workers’ pneumoconiosis.

All of these activities culminated in the Coal Mine Health and Safety Act of 1969 and the Occupational Safety and Health Act of 1970. The latter act man­dated the creation of both the Occupational Safety and Health Administration (OSHA) in the U.S. De­partment of Labor and the National Institute of Oc­cupational Safety and Health (NIOSH) in the De­partment ofHealth and Human Services (previously Health, Education and Welfare). OSHA was to set and enforce national standards of safety and health on the job, and NIOSH, the research arm, was to determine safe levels of industrial pollutants.

With the decline of heavy industry after 1960 and the rise of white collar and service industries, many people argued that occupational disease was a leg­acy of the industrial era. Yet the problem of occupa­tional diseases has merely taken on a new form. The emergence of a strong environmental movement has once again focused attention on the dangers of indus­trial production at the same time that it has broad­ened the scope of what was once seen as a problem for the industrial work force alone. The emergence, for example, of a nuclear power industry — whose domain ranges from the production of atomic weap­ons to nuclear medicine — has heightened awareness about the danger that radiation poses for workers even in the most highly technical professions. Fur­thermore, the problems of industrial and atomic waste disposal have forged a link between those who are concerned primarily about protecting workers and environmentalists.

Moreover, as international economic competition intensifies and workers and professionals alike expe­rience intense pressure to increase the speed of pro­duction and improve the quality of products, the scope of the definition of occupational disease contin­ues to broaden. Stress, for example, which was once considered a problem of executives, is now a major reason for compensating claims in California. And some miscarriages have been linked with exposure to low-level radiation from video display terminals.

Until the 1950s, the history of medicine was often Xmderstood to be the history of infectious disease. However, with the evolution of chronic, noninfec- tious disease as a major public health problem, indus­trial illnesses have taken on a new importance and are no longer mere oddities in a “cabinet of curiosi­ties.” Indeed, industrial disease may prove to be a model for understanding all noninfectious illness, for those physicians, government agencies, and pro­fessionals who study it will be forced to address a host of questions regarding social and political re­sponsibility for society’s health. In fact, ultimately, industrialized countries will be forced to ask what level of risk is acceptable for industrial progress and who should bear the cost.

Gercdd Markowitz and David Rosner