Document OEp2BDJao3w21B5J2ZwYonRNj

--- VOLUME V BALTIMORE THE JOHNS HOPKTNS PRESS 1937 ON THE HISTORICAL INVESTIGATION OF OCCUPATIONAL DISEXSES AN APERCU GEORGE ROSEN, h1.D. Although the investigation of medical history is being pursued to-day with greater vigor than ever before, there is one field of medicine which has remained comparatively neglected by the medical historians, namely, the occupational diseases. In order to understand this state of affairs certain preliminary considerations are necessary. If one stops for a moment to consider the nature of historical research it is immediately apparent that an analysis of any aspect of this subject must be dual in character; the analysis must consider not only the development of the particular subject matter under consideration but it must also consider the nature of the mental conceptions involved in the methodological approach. Let us first consider the latter factor. I t will necessarily be conditioned by the current view of historiography. The modern conception of history is comparatively recent. From antiquity until well into modern times history concerned itself with affairs of state. one English historian expressed this viewpoint history was past politics. Neither the masses nor anything concerning them were deemed worthy of interest. With the modern introduction of political and civil equality in the nineteenth century and under the influence of the social sciences with their important discoveries concerning the nature of man and the social organism, the time-honored conception of history had to be revised. Inevitably the political orientation in the study of history gave way to a broader view which took into account, not only war and government, but also industry, commerce, science, technology and everything else that conditions man's social existence. In consequence, towards the close of the nineteenth century the New History, as the all inclusive societal view became known, had given an enormous impetus to the investigation of those aspects of human activity which, precisely because of their assumed inferiority, had received scant attention. Among these social activities, medicine assumed a place as subject for historical research. 941 942 GEORGE ROSEN The methodological approach was based upon theoretical conceptions conditioned, not only by the development of historiography outlined above, but also by the development of medicine itself. Despite the fact that medicine in its origins arose in answer to a fundamental social need-the problem of disease-it nevertheless developed to a large extent on an individualistic basis. Disease was dealt with individually ; the sick man was treated without mu& attention being paid to the possible relationship existing between his disease and his background or surroundings. Physicians, accustomed to observe human life, could not fail to recognise that social conditions exerted great influence upon man both in health and disease. Since medicine, however, was developing upon the atomistic basis of the diseased individual as its chief concern, this problem was neglected and remained outside the province of the physician's activities and interests. The rise of capitalism and the introduction of the Industrial Revolution at the close of the eighteenth century created the masses of the modern industrial proletariat. Forced to crowd into insanitary slums, doomed to starvation by the iron law of wages pontificated by the bourgeois economists and suffering periodically from unemployment, the lot of the industrial workers was a miserable one. Through the initiative of the working class and through the efforts of socially minded individuals the public conscience was aroused to combat these evils. Social questions of the greatest moment-uestions of labour legislation, of public aid, and of hygiene and sanitation-agitated the body politic. Legislative and administrative measures calculated to alleviate and remove the worst evils were enacted. The result was that medicine was forced to take notice of and enter into the field of social politics. From this moment on. the entire viewpoint of medicine was radically altered; now it was concerned not only with the diseased individual but with a more inclusive whole, the diseased social organism. The investigation of the sick man as a social organism demands the investigation of man as conditioned by his environment, his work, his home, his struggles and aspirations. Thus medicine joins hands with sociology and every part of medical knowledge acquires a social content. 944 GEORGE ROSEN represents a distinct advance over the older theory it does not go far enough in its analysis. Cultural currents-be they philosophical, artistic or political-are no more than the surface manifestations of much more fundamental forces determining the direction of social development. Society is not a simple arithmetical aggregate of men. The various aspects of human activity are conditioned by the economic structure in which they are embedded and which imposes certain definite relations upon them. The application of this theory to the history of medicine requires the consideration of various factors which had previously remained comparatively unnoticed. It focuses attention on the necessity for investigation of those aspects of social activity which, since they were the concern of the working classes, had not been considered worthy of interest. Technical processes, the daily routine of mine and factory, the conditions under which the worker lives-all are seen to esist in a deep and significant relation to medical thought and practice. -4 new light is thrown upon the functional relations of medicine in society by considering the physician as an economic unit in a society Lvith a particular class structure. Social conditions, with which medicine is brought into intimate contact undoubtedly influence the development of medical thought and practice and condition the direction which they take. It seems therefore to offer a suitable theoretical method of approach to the complex social and economic problems of medical history. Investigation of these problems offers an opportunity for new discoveries and interpretations in the history of medicine, leading eventually to a profounder understanding of the dynamic processes, which govern the relations between medicine and other social activities. It now becomes evident that several reasons may be advanced to explain the neglect which the historical study of occupational diseases has experienced. In the first place it is apparent that the study of occupational diseases is one of the youngest branches of medicine and that only within recent times has it come within the province of the practicing physician. The accumulation of a considerable body of factual knowledge was necessary before any historical study could be attempted. Secondly the lack of an appropriate theoretical basis for investigation very definitely retarded the study of this branch of medical history. HISTORICAL INVESTIGATION O F OCCUPATIONAL DISEASES 945 Research in the field of occupational medicine needs no special apology. In view of what has been said above, one can readily understand that the results of these investigations will be of great significance, not only in comprehending the development of industrial medicine and hygiene to the condition in which it confronts us to-day, but in a larger sense for the study and understanding of man's social evolution. Historical research on this subject will necessarily concern itself with many factors. The relations of some of these factors to the topic being investigated will not be immediately apparent. X brief glance at the various factors involved in the study of any occupational disease or group of diseases will suffice to demonstrate the numerous ramifications of industrial medicine in society. These factors must of course be located in a definite frame of reference e. g. in a particular time sector. This premise demands as a prerequisite a consideration of the factors which determine the aspect and condition the culture of the period under discussion. -According to that theory which appears most promising for the historical investigation of occupational medicine the productive forces at any given time are the basis of the social structure of that time. The methods by which the productive forces are put to work-the mode of production-are conditioned by given factors, the most important being the state of technics during the particular period. Technics include not only material technique,-technologybut also mental technique, i. e. conceptional structures, which arise in answer to definite needs. The frame of reference, necessary to locate the object of investigation, would then include a general description of the social structure in its economic, technologic, political, religious and cultural aspects. The definition of these elements is indispensable, since the two groups of people with whom the student of the history of occupational medicine is primarily concerned, the workers and the physician are conditioned by these aspects of their society and their relations are to large extent determined by them. Having sketched the basic outlines of the picture, the field of investigation must then be confined to the particular industry under scrutiny. I n this narrower field the technical side of the industry must be examined, the working conditions determined and the existential relations of the 946 GEORGE ROSEN worker n-ith respect to aspects of society, such as religion and p l i tics, studied for any bearing they may have on his social status. Once these facts have been established, the medical aspects of the problem must be attacked with the view in mind of ascertaining the diseases described during the period. The extent of medical knowledge pertaining to the nosology, etiology, pathology, clinical aspects and therapeutics of these diseases should be determined. I t will necessary to determine how widespread this knowledge was among practicing physicians and what actually was done to prevent and cure these diseases. These elements will to a large extent be dependent upon the state of medicine at the time. Prophylactic measures on the other hand must be investigated with regard to the state of development of technology and the social status of the worker concerned. The final aspect, which should be investigated, in order to round out the historical picture of industrial disease at any particular time, should be statistical in nature. This information should be concerned primarily with mortality and morbidity, and will naturally depend on the co-existent state of statistics. Since statistics, particularly with reference to disease, are of rather recent origin, any references in earlier periods to this aspect of industrial disease will naturally be vague, meager and rather crudely expressed. Legislative and administrative measures calculated to eradicate or palliate industrial evils, by the very nature of their purpose, belong in an historical study of occupational diseases. Research will logically concern itself with the origin of these measures, attempting to ascertain the social forces which brought them into being. The part played by the advance of medical knowledge and the role of the workers in obtaining needed industrial reforms will be of special interest. This sketch has made it sufficiently clear that the time has come for a new appraisal of the history of medicine. It is very likely that the development of research concerning the history of industrial disease will lead the way in this process. Be that as it may, however, the history of occupational medicine will certainly, by explaining their development, contribute to a better understanding of and a deeper insight into many of the pressing problems of our industrial society.