THE RISE AND DECLINE OF WORKMEN'S COMPENSATION Victorian Britain can be seen in terms of a largely full-employment but low-welfare society. In such circumstances a workman's greatest need was for a fit and healthy body, for only with such could he expect to perform the work required to obtain for himself and his family food, shelter and clothing without recourse to the poor law, private charity or other forms of non-wage financial support. One of the major threats to bodily and material sufficiency, especially for miners, railwaymen, merchant seamen and Others in dangerous employment, was provided by industrial injury or disease without compensation. 2 It was not until 1897 that Parliament passed a Workmen's Compensation Act giving large groups of workers, in the event of physical injury, a statutory right to compensatiin from their employers regardless of the employer's fault and largely regardless of their own part in precipitating their misfortune. This Act established what Beveridge was later to call 'the pioneer system of social security'. 3 Its operation will be one focus of this paper, but first we may look at the position of victims of occupational injury before the passing of that Act. u Until 1837 there was no reported High Court case of an employee suing his master for damages as a result of injury negligently sustained at work. But the precise significance of this fact is not altogether clear, for suits may have been decided by local courts. This, indeed, is quite likely to have been the case. By tracing back the first High Court case, that of u v. u,4 to its place of Origin, rural Lincolnshire, we find nothing in local newspaper reports to suggest it was unique.5 Furthermore, we know from other legal evidence that by the 1830s the idea that a master Owed a duty of care to particular individuals in his employ, for example, apprentices, was well established.6 All this being so, we are faced with the question of why it was as late as 1837, by which time the process of industrial- isation was well advanced, before a personal injury action by an employee against his employer reached the High Court. It surely was not the Case that work injury was new, for common sense tells us that industrial and agricultural accidents are as old as mankind itself. Part of the answer may be provided by an understanding of the paternalistic nature of pre-industrial society, in which production was quintessentially an activity of small units in which a master shared labour with workers who were often members of his own household. In such Circumstances it is easy to see that the prevention, treatment and compensation of accidents and accident victims occurred on a personal level without recourse to the courts. It is a truism that under the pressures of industrialisation this social relationship broke down to be replaced with one dominated by class conflict and the cash nexus. 7 In these circumstances industrial injury became a matter for the Courts, for Acts of Parliament and government inspection. Yet even this interpretation fails to explain why u v. u Occurred so 'late', for most historians would agree that by the 1830s industrialisation had long revolutionised English society. Thus, in Order further to account for the absence of case law we must point either to the problems encountered by workmen in suing their employers or to the continuing charity of those employers when faced with labourers injured in their service. There can be no doubt that to commence legal action against an employer was a very serious step for a workman to take. Unless supposed by a wealthy patron (in the 1840s Lord Ashley financed several employers' liability suits), an action was likely to be ruinously expensive; it could also mean dismissal with the certainty that no other master in the district would ever hire the 'troublemaker' again. 8 Furthermore, given the social composition of those hearing Cases - middle to upper-class judges and a jury selected on a Property qualification - the chances of success were limited.9 At the same time, it is unrealistic to suppose that all employers were totally hard-hearted in their attitudes towards injured employees. Private philanthropy and charity did not die with the establishment of industrial capitalism; Charles Dickens's Bounder by and Scrooge were not typical examples of nineteenth century businessmen. Hence a realistic appraisal of why there were no cases before u v. u must emphasise both the difficulties facing the injured and the likelihood that many masters made at least some reparation to injury parties. u v. u was not followed by an avalanche of litigation. Indeed, it was not until the 1850s that there occurred an action arising from the new conditions of industrial life (the Priestley case, which was lost by the plaintiff on appeal, arose from injuries sustained through the over-turning of a butcher's cart). From the 1850s, as more cases arose, the common law underwent considerable modification. The effect of much of this was detrimental to the chances of plaintiffs securing judgment. In particular, in the decades following u v u, the courts developed three so-called legal 'fictions' : common employment, contributory negligence, and u which, together with the continuing problem of financing legal actions, combined to render employers' liability for personal injury virtually a dead letter. We may now consider briefly the significance of the three 'fictions'. Lord Abinger, when giving judgment in the Court of Exchequer on u v. u stated, not altogether accurately, that there was no precedent for the present action by a servant against a master'. He went on to say that his decision would, therefore, be based upon 'general principles'. The general principle influencing his finding for the appellant, Fowler, the butcher, was that to decide the other way would be to 'open the floodgates' of litigation with 'alarming' consequences. Such policy, rather than legal, considerations informed much judicial thinking over the early and mid-Victorian period. Thus, building on the judgment in u v. u and a later American case, u v. u,10 the Court of Exchequer introduced the doctrine of common employment to English soil in u v. u (1850).11 The judgement held that no action could lie if a work injury or fatality were caused by a person in common employment with the injured party, that is, a fellow-workman. As the scope of common employment was later extended, the rule came to mean that even managers were deemed to be in common employment with manual labourers. Before this rule was abolished by the Law Reform (Personal Injuries) Act 1948, it excluded many injured workers from damages.12 The same was true of the defence of contributory negligence, whereby no action could succeed if it were shown that the accident victim was to any degree responsible for his fate. This defence was not amended until 1945.s The third 'fiction' was that of u, which was the principle that in accepting dangerous employment a workman willingly consented to the risks and implicitly renounced all claim to be compensated. Hence, for an action to succeed it became necessary for the plaintiff to demonstrate that his injuries were wholly and directly the fault of his master and incurred in circumstances excluding the defence of u. In an economy increasingly dependent on a complex division of labour in large units of production this was very difficult to achieve. Accordingly, only a few successful actions occurred before amendment of the law in 1880. None of the above barriers applied outside the workplace. Thus, while successful actions by injured railway passengers against railway companies were relatively commonplace, it was virtually unknown for an injured railway servant to secure damages.s An abortive attempt to abolish common employment was made in 1862, but sustained reforming activity only got off the ground with the passing of the Second Reform Act (1867) , the foundation of the TUC (1868) and the election of trade unionists to Parliament (Alexander Macdonald and Thomas Burt in 1874) . During the seventies a number of Bills, mostly aimed at limiting or abolishing the common law defences against employers ' liability actions, came before the House. A Select Committee investigated the question which became an election issue in 1880.s Throughout this long period of public debate employers and their representatives claimed that a change in the law would mean disaster for British industry. Their adversaries, on the other hand, claimed that they only wanted working people to be put on an equal footing with the rest of the community. In 1880 the hopes and fears of the conflicting parties seemed to have been realised when Gladstone' s newly elected government secured the passage of the Employers' Liability Act.s For all the intense debate over much of the preceding decade and for all the extravagant claims, pro and anti, made for the various Bills of the 1870s, the 1880 Act represented only a minor adjustment to, rather than a revolution in, liability law. It abolished the doctrine of common employment in only four specific circumstances; the Act did not apply to seamen, domestic servants or, with the exception of railway servants, non-manual workers; a ceiling of three years ' wages was placed on damages recoverable under the Act, a particular hardship in the case of minors; the defences of u and contributory negligence remained. Furthermore, in some localities the significance of the Act was further restricted by the widespread practice of contracting out whereby workers signed away their right to take advantage of the Act.s Since the necessity to prove fault remained and since nothing was done to help finance actions or redress the inequality of plaintiffs and defendants, it is clear that the 1880 Act was no more than a moderate reform. Consequently, almost as soon as it became law, the movement to amend it began. During the eighties and nineties a rash of Employers' Liability Bills, many drawn up by the TUC, came before Parliament. Most of these Bills tinkered with the principal Act by proposing such reforms as the abolition of contracting out, further erosion of common employment, the raising of the maximum level of compensation, or the inclusion of further categories of employee. They failed because a Parliament in which the working man continued to have a limited voice was unwilling to re-open a question considered to have been settled in 1880. The objective behind these reform attempts was to place a bigger and more certain financial burden upon more employers in order, partly, to compensate the injured, but also to increase financial incentives to adopt safety precautions. However, given that most employers insured their risks, there was little likelihood that the reformers ' safety intentions could be realised. Although industry was becoming safer throughout the nineteenth century, there is little evidence to suggest that amendment of liability rules played much part in the process. In 1893 Herbert Asquith, Gladstone' s Home Secretary, introduced an Employers' Liability Bill in the Commons. When it came up for its second reading joseph Chamberlain moved an amendment which was to revolutionise developments in industrial compensation: . . . no amendment of the law relating to Employers' Liability will be final or satisfactory which does not provide compensation to workmen for all injuries sustained in the ordinary course of their employment and not caused by their own acts or default.s Chamberlain' s point was that even a reformed employers ' liability law would leave uncompensated all those whose injuries were caused by 'act of God' . If employers were to be held liable for accidents over which they had no personal control, it was fair and logical that all victims who were not themselves negligent should gain redress. Such a proposal, calling for workmen' s compensation on an insurance rather than a negligence basis, was not entirely original; it harked back to insurance ideas raised in the debate over the 1880 Act and proposals for reform made by Edwin Chadwick in the 1830s and 1840s.s The difference was that Chamberlain' s amendment yielded a legislative consequence, the Workmen' s Compensation Act, 1897. Before this Act was passed there was, of course, a great deal of parliamentary and extra-parliamentary debate, much of it involving the conversion of hostile parties. Even in 1897 the TUC and individual unions remained critical of the insurance solution.s Why this was so is arguable. The unions themselves claimed to oppose any measure which removed the costs of accidents from the employer, thereby also removing safety incentives. Their critics, on the other hand, argued that it was unrealistic to suppose that employers were bearing the costs of a significant proportion of accidents. They maintained instead that unions favoured tort law because it safeguarded their own interests both by nurturing industrial tension and by constituting a powerful recruiting device (unions made great play of the legal and financial assistance they rendered to injured members). If the unions were unenthusiastic about workmen' s compensation, so too were employers for they were gaining a potentially huge overall liability to pay compensation regardless of fault. Ultimately they were readier to accept this than the alternative, that is, a revamped employers ' liability law whereby they might incur the obligation of paying large and unpredictable amounts of damages. The merit of workmen's compensation, in their eyes was that it would involve relatively small individual sums for which budgetary provision could be made. But it is significant that workmen' s compensation was backed by no powerful interest groups - it was a compromise measure. This point goes some way towards explaining the broad based hostility aroused by the Act in operation. u The Act was extremely complex, but essentially it stated that: ' If in any employment to which this Act applies personal injury by accident arising out of and in the course of employment is caused to a workman, his employer shall . . . be liable to pay compensation . . . ' regardless of his fault in causing the accident, and, largely, regardless of the part of the workman in bringing about his injury. The places of employment to which it was applicable were defined as 'on or in or about a railway, factory, mine, quarry, or engineering work, and . . . on, or in or about any building which exceeds thirty feet in height and is either being constructed or repaired by means of a scaffolding, or being demolished, or on which machinery driven by steam, water, or other mechanical power, is being used for the purpose of the construction, repair, or demolition thereof' . Compensation, which was payable from two weeks after the accident, was to be based on previous earnings with a ceiling of #300 for a lump sum in the event of death, and up to #l per week in cases of total or partial incapacity.s The Act came into effect on 1 july 1898. The new Act was greeted in emotional terms by its supporters and opponents. Some employers felt it would cripple the international competitiveness of British industry despite the fact that other countries, notably Germany, already had similar legislation. On the other hand, its champions considered it to be ' a great boon' to workers. One historian terms the Act ' revolutionary' and has even gone so far as to claim: 'There can be no doubt that the Workmen' s Compensation Act was one of the most important ever passed by Parliament' .s This is certainly claiming too much for a measure which (until 1906) applied to only a minority of the country's total workforce, imposed relatively low ceilings on maximum awards and relatively complex regulations on eligibility for benefit. However, the Act was of significance in one practical and one symbolic way. It established work injury victims as an elite group, analagous to war pensioners, eligible for special benefits denied to other, perhaps similarly injured, members of society. This position was consolidated as later legislation substantially enlarged the size of the elite. Moreover, even after the substitution, in 1946, of the Industrial Injuries Scheme for the workmen' s compensation system, the preferential treatment of work injury victims was retained. The symbolic importance of the 1897 Act was in conferring a working-class right - comparable with the right to vote or to form trade unions - which, if it did not remove the longstanding disadvantages of the negligently injured worker relative to those injured outside the workplace, promised to circumvent them. Hence, symbolically, the Act constituted another step towards workers' achievement of social, legal and political parity with fellow citizens. Whether the Act' s practical impact warranted the hopes and fears of those who witness its passing is another matter. The next two sections consider the scope and significance of the workmen's compensation system in operation. u It is not easy to determine the scale of workmen' s compensation during its early years owing to the severe shortcomings of the statistics. For this reason and to avoid the interruption of the war years, during which no statistics were collated, attention here will be confined to the figures for the inter-war years, principally for the seven industries (factories, mines, shipping, docks, quarries, railways and construction work) which were required by a 1907 Home Office order to compile detailed workmen' s compensation statistics. Since these seven industries accounted for a large proportion of compensation cases and payments much may be surmised from their statistics about the overall dimensions, costs and effectiveness of workmen's compensation.s By the end of the 1930s (see Table 2.1) over 450,000 compensation cases were each year generating payments of close to $7 million for accident victims and their dependants. This meant that every year some 5 to 6. S per cent of the workforce in the relevant industries were making a u claim for compensation. Hence, on average there was a strong possibility that in the course of a working life u u every eligible workman, and especially those engaged in the dangerous trades, would have recourse to workmen' s compensation at some time. In fact, aggregates of benefits and cases tend to minimise the dimensions of the system in two ways. Firstly, case numbers refer to numbers of accident victims; the annual number of beneficiaries in any single year clearly exceeded one million if dependants are taken into account. Secondly, published figures for payments refer only to direct benefits; they exclude legal, medical and administrative costs, insurance company profits and money paid by insurers into their reserves. There is no way of ascertaining precisely how much these additional factors would have inflated overall costs. The Home Office did, however, publish rough estimates of the total cost of compensation in the seven industries (Table 2.2) and, from 1930, of all industries (Table 2. 3) , but these provide no more than a general indication of overall expense and should not be relied upon for indications of trends. was not, however, the only variable affecting the financial needs of The fundamental question arising from the statistics presented in these Tables is whether they should be considered large or small. It is impossible to provide an objective answer, for any conclusion must rest, upon assumptions of magnitude relative to other indices of expenditure or some notion of what burden society could or should afford. Some observers looked at the plight of impoverished families stripped of their breadwinners and concluded that compensation should be greater; others looked at struggling industries and claimed that a contributory cause of British industrial decline was the extent of expenditure on social services relative to that of overseas competitors . Naturally, the division of these views tended to be between employers and workers, trade unions and employers ' organisations, Labour and Conservative Parties . The Balfour Committee on Industry and Trade appointed by Ramsay MacDonald in 1924, looked into the question of industrial costs as part of its inquiry into factors affecting industrial and commercial efficiency. Its final report concluded that although social service expenditure was under one per cent of the gross value of output and therefore relatively insignificant it 'may in certain cases be a very appreciable element in costs, and there is every reason for continued vigilance to ensure the maximum of economy' .s Compared with other social service expenditure, the overall scale of workmen' s compensation costs was not great. But workmen' s compensation was the only scheme financed entirely by employers. If there were grounds for criticising its adequacy in individual cases, as there were, this was little consolation to the scheme' s paymasters in times of national economic difficulty. u There can be little doubt that the 1897 Act failed to measure up to the extravagant claims made for it at the time of its passing. One of the principal shortcomings was the level of benefits payable. Average weekly payments of some lls per week in 1902 (average wages were then about 26s 6d) were modest indeed. In relation to living costs the value of benefits, which was subject to constant criticism, especially by the trade unions and the Labour Party, improved little over the years. There are innumerable examples of such criticism, even from such unimpeachably obj ective sources as the u which, in 1928, called benefit scales (revised by Parliament in 1923) 'tragically inadequate' .s Looking back on this issue in 1945, a solicitor, in evidence to an official committee, claimed that 'the fundamental vice of the Workmen' s Compensation Acts was the misery and injustice inflicted upon the injured workmen by the grossly inadequate weekly payments ' .s A working man' s view of benefits is provided by the evidence of a Canadian carpenter submitted to the Nuffield College Social Reconstruction Survey in the early 1940s: 'I have searched my dictionary from the front to the back to find a suitable word to express the opinion of the consumer and failed to find it'.s When it is remembered that workmen' s compensation benefits were based primarily upon previous earnings and took little or no account of needs, the significance of the actual sums paid to beneficiaries becomes clearer.s A father of six children who was injured at work could expect to receive no more in compensation than a similarly incapacitated married, yet childless, man. The financial consequences of industrial disability could, therefore, vary greatly. Family size was not, however, the only variable affecting the financial needs of the injured; the nature of the injury was a further factor. Yet workmen' s compensation benefits took no account of hospitalisation, other medical treatment or the necessity for equipment such as artificial limbs. Clearly, recourse to any of these facilities could prove a severe drain on a worker's resources. Although a trade union might provide legal expertise to the minority of workers who were union members, an injured employee' s expenses arising from his injury could pose severe financial difficulties before the problem of income replacement arose. Of course, workmen' s compensation was not intended to provide in full for the financial loss sustained by work accident victims ; it was not even meant to compensate in full for lost earnings (and the Act provided nothing for pain and suffering, and disfigurement). It was intended to share the loss occasioned by an accident between employer and employee; but given that workers sustained the physical loss as well as a financial loss, it is arguable that the share-out was inequitable. Inadequate compensation was only one grievance of those who succeeded with a claim under the Acts. Another was the delay in obtaining a settlement. This could take up to one year; for a family stripped of its breadwinner, possibly with few savings and, perhaps, also incurring substantial expenses arising from the injury, such delays could be a very serious matter.s More serious still was the absence of any security that payments would be maintained. The 1897 Act permitted claims by those injured under circumstances specified in the statute and laid down scales of payment and procedures for securing settlement. It did not, however, guarantee benefits . If an employer or an insurer went out of business, those in receipt of weekly compensation payments became creditors and ran the risk of losing most or all of their regular entitlement. Parliament and various governments made efforts to improve the financial security of beneficiaries by giving them a prior claim on assets over all other creditors, by regulating the insurers and by making insurance compulsory in the coal industry.s The effect of these changes was , however, marginal and uncertainty about benefits continued to be a criticism of the workmen' s compensation system down to the 1940s. The numbers who lost benefits may not have been great in relation to the total number of beneficiaries, but their plight attracted considerable attention since it highlighted a major defect in the legislation, namely that a legal right conferred upon a particular group could on occasion be literally worthless. Shortcomings in scales of benefit, rapidity and certainty of payment were, in a sense, secondary problems of workmen's compensation, for those who experienced them had at least succeeded in pressing a claim. Before reaching this stage the claimant and his advisers had to negotiate their way through a maze of ambiguous legislation, contradictory judicial decisions and the risk of litigation. In the early years of the twentieth century few legal authorities referred to the Workmen' s Compensation Act in complimentary terms . For Parsons and Bertram it had ' singularly drawn provisions'.s According to Lord Brampton The whole statute is full of incongruities. In it so many things are said which could not have been meant, and so many things which must have been meant are left unsaid, that one often has great hesitation in even framing a conjecture as to what may have been the views and intentions of its framers. Many problems derived from the attempt, largely abandoned in 1906, to restrict the scheme to certain groups of workers while excluding others. Hence, the 1897 Act specified that compensation could be claimed by accident victims in the building trade when their accident occurred on ' any building which exceeds 30 feet in height, and is either being constructed or repaired by means of scaffolding' , but not by other building workers. This led to a host of disputes regarding the nature of scaffolding and the meaning of the 30 feet rule (for example, could a well which was more than 30 feet deep be considered a building in excess of 30 feet high? What was the position with buildings intended to exceed 30 feet, but of lesser dimensions at the time of the accident? In measuring a building should foundations and/or chimneys be included? How was a building on sloping land to be treated? Could a chair or crawling board be considered scaffolding within the meaning of the Act?).s While the 1906 Act removed many anomalies and arbitrary distinctions of this kind, it left others, including the notorious phrase: 'arising out of and in the course of employment' . As Lord Loreburn said in u v. u, the words of this clause admitted of inexhaustible varieties of application according to the nature of the employment and the character of the facts proved'.s This and other clauses were still providing problems of interpretation and much lucrative work for lawyers in the 1930s. But how much litigation did occur under the Workmen' s Compensation Acts? One of the objectives of the framers of the 1897 Act had been to remove compensation from the purview of the courts, the aim being to enable workmen to recover without the expense and difficulty of legal proceedings necessitated by the obligation to prove fault. The expectation was that settlements would be agreed informally between employers and employees with arbitration (which could take place in the County Courts) occurring in only a minority of instances. The settlement of claims was much more contentious than had been somewhat naively anticipated. This was partly because of the policies of the insurance companies (see below) , and partly a result of poorly drafted legislation and inconsistent County Court decisions; but more basically it was because a workmen' s compensation claim involved complex negotiations over money between the two sides of industry in the emotional circumstances of death or injury. just how contentious settlement of claims was, however, was itself a matter of contention. Initially this was because the statistics failed to provide an accurate guide to the problem. In these circumstances the Act gained a reputation, based upon accusation, for encouraging litigation. The literature, ranging from the popular press to specialist periodicals, law reports, law texts and u bristles with such references as the 'flood of litigation' ,'nothinng but litigation' and 'more litigation than any other Act which has been passed in recent times' .s In 1935 Professor William Robson could still refer to the 'immense volume of litigation' : The truth of it is indisputable. In the space of less than forty years the legislation which was specially designed to give the workman a simple, cheap and easy remedy for his injuries has become encumbered with an ornate, seductive, writhing mass of case law which suffocates the whole scheme by loading it with expense delay and difficulty. s Historians and lawyers who have waded through Butterworths ' Workmen' s Compensation Cases are likely to sympathise with Robson's extent of litigation by emphasising that relative to the number of mutually agreed settlements it was small.s This was reasonable so far as it went - though even a relatively small amount of litigation might be viewed as excessive in a no-fault system - but it ignored the possibility that many contentious cases were settled by informal agreement on terms unfavourable to workmen owing to imprecisions in the legislation and the prohibitive costs, especially for non-unionised labour, of going to court. The litigation problem persisted throughout the existence of the workmen' s compensation system.s It soured industrial relations, pushed up costs and ultimately provided one of the most powerful arguments for changing the system. If litigation and scales of benefit were two of the major criticisms of workmen' s compensation, the third was the insurance system. When the 1897 Act became law it was assumed that most employers would seek insurance to cover their liabilities. This would protect them from the financial burdens of large claims as well as safeguarding the rights of claimants who might be deprived of benefit if their employer was unable to pay compensation. The Act introduced no compulsion to insure; it was simply assumed that employers would do so in their own best interests. But claimants had no protection if a small uninsured employer found himself unable to meet compensation payments, or if his insured employer, large or small, became incapable of maintaining insurance premiums . Consequently, the Act could be said to have fallen between two stalls. It failed, as we have seen, to guarantee that benefits would be paid in respect of legitimate claims. At the same time, by allowing insurance there was the possibility that any influence which the Act might exert in the direction of improving safety via economic deterrence would be undermined as the employer' s liability became to some extent the insurer's liability. There are few data on the extent to which claims were lost through bankruptcies. Some were gathered during the early 1930s in response to concern about what was happening in the coal industry. Though their accuracy was disputed at the time, they suggested that between 1 january 1927 and 30 November 1933 280 colliery insolvencies occurred. In these cases an unknown number of workmen experienced temporary deprivation of benefit. In 24 cases permanent losses were sustained, while in a further 11 the possibility of such losses remained. Thus, at least 245 insolvencies involved no permanent loss. But it was estimated that the 24 confirmed cases involved losses for some 1,500-1,700 claimants exceedings #170,000.s These were not insignificant figures; moreover even temporarily lost compensation could involve considerable hardship. As a result of public concern over the sufferings of uncompensated colliers an Act of 1934 made workmen' s compensation insurance compulsory in the coal industry. Such insurance would remain valid, notwithstanding failure to pay premiums, provided that a claim arose when the colliery was insured.s While the 1934 Act was significant in terms of principles, its effects were confined to one industry alone. The question of non- payment of compensation by uninsured insolvent employers continued to be raiseds in Parliament intermittently for the remainder of the thirties.s Furthermore, compulsory insurance, demanded in some quarters virtually since the 1897 Act had become law, remained one of the main workmen's compensation reform priorities of the trade unions and Labour Party into the 1940s. Of course, if compensation insurance were obligatory there was a strong case that it should be economic, fair and efficient and many voices claimed that the system which emerged after 1897 was none of these. In 1912, at which time the insurance companies were responsible for some 33 per cent of workmen's compensation payments, only 63 per cent of premium income was going towards benefits, the rest was financing commissions, management expenses and profit. Moreover, of the 63 per cent an undisclosed amount consisted of legal and medical expenses. The Holman Gregory Committee found, in the early twenties, that only some 48 per cent of premiums were being paid in benefit while profits exceeded 20 per cent. This prompted the recommendations that there should be government supervision of premium rates, and that at least 70 per cent of premium income should be paid out in benefits.s A Home Office minu of 1922 recognised that companies' premium rates were a 'scandal'.s In the following year the government reached agreement with the Accident Offices Association, to which a large number of companies undertaking workmen's compensation business belonged, to the effect that compensation payments would be not less than 5 per cent of premium income, rising to 62.5 per cent in 1926.s u feared that the agreement threatened insurance companies probability.s However an arrangement which allowed 37.5 per cent of premium income to finance operating costs (exclusive of medical and legal expenses, which continued to be categorised as compensation) and yield a profit cannot be accounted particularly severe. In the mid-thirties Professor William Robson could continue to attack the insurance companies for frittering away premiums . Indeed, he blamed them for much of the 'human suffering, economic waste and social injustice' which he associated with the workmen' s compensation system.s At first sight it would appear that there was much justification for charges such as Robson's against the insurance companies . Furthermore there is some evidence that the companies engaged in unethical and unscrupulous practices, including inducing recently injured workers to sign away all future claim to compensation in return for relatively small cash payments. But it has to be recalled that insurance companies controlled less than one-quarter of the market (22 per cent of payments and shrinking in 1932). Most employers were in mutual associations (44 per cent of payments and growing) or carried their own risks (34 per cent of payments). In several industries, most notably railways, shipping and mining, the companies' share of the market was negligible. It is, therefore, unrealistic to blame the insurance companies for all the ills of the workmen' s compensation system. Mutual association was the more typical form of insurance, and here, overheads were very much lower - that is, some 20 per cent or less of premium income - than for the proprietory companies. Yet the latter were widely assumed to dominate the market. In the early stages of his Social Insurance and Allied Services Inquiry Sir William Beveridge appears to have shared the notion that all workmen's compensation insurance was wildly expensive and wasteful . Further investigation led him to doubt whether this was the case. In 1942 he found that the proprietory companies were responsible only for some 15 per cent of all compensation payments, whereas mutuals covered some 70 per cent of the market. He also came to see that there were explanations other than profiteering or inefficiency for the companies' high expenses, for whereas mutuals covered big employers in common industries, the commercial companies dealt with many small employers in a wide variety of trades (including employers of domestic service) . In July 1942 Beveridge wrote: 'The expense of insurance with commercial companies cannot well be used as a principal argument against the present system workmen' s compensation. There are many stronger arguments'.s Nevertheless, misconceptions about workmen' s compensation insurance were so widespread that it is probable that they exerted considerable influence in bringing about reorganisation of the workmen' s compensation system. Safety was a prime consideration of the framers of the 1897 Act, who believed that by imposing the costs of accidents upon employers a more safety conscious attitude would emerge. The danger was, however, that insurance would exert an adverse effect upon industrial safety by imposing the direct cost of compensation upon the insurer rather than the employer. Such a consequence might have been avoided by means of merit rating, that is, the variation of premiums according to accident prevention steps taken by the employer. Such a practice was commonplace overseas. However, the Holman Gregory Committee found that in Britain insurers made little use of a rating system likely to encourage employers to introduce positive safety measures.s The conclusions of this Committee were similar to that of an earlier official inquiry which had reported that: 'No evidence has been brought before us which enables us to find any improvement in the direction of safety is to be placed to the credit of this Act' .s Although Beveridge considered that workmen' s compensation insurance facilitated accident prevention by allowing premiums to be adjusted to ascertained risk, there was virtually no evidence to support this argument.s Indeed, the government subsequently discounted Beveridge' s view.s In safety terms the Workmen' s Compensation Acts must be judged to have failed. u Beveridge listed nine disadvantages in the workmen' s compensation system; there were certainly more than can be discussed in this chapter, but inadequate and uncertain benefits, heavy litigation, unsatisfactory insurance, and lack of safety incentives were (rightly or wrongly) the main charges against the system. These channelled into the overriding deficiency of workmen' s compensation, namely, its adverse effect upon industrial relations. The system was a conflict-oriented one in that it pitted employer and employee against each other over money matters. This conflict was institutionalised by the involvement of trade unions, employers' associations and insurers with the effect that compensation negotiations sometimes resembled battlegrounds between labour and capital, with each side represented by its battalions of professionals - the doctors and lawyers. One should not over dramatise this; it is important to remember that thousands did receive benefit with relatively little difficulty or delay. If this was inadequate in terms of meeting victims' needs or returning them to their pre-accident financial status, it should be emphasised that the workmen's compensation system was a great advance on the pre-1897 posi;tion. Of course, as expectations rose so dissatisfaction with this sort of rationalisation increased. But the crucial point is not that workmen' s compensation was a flawed system - few would have disputed this - but that it was widely believed to have been much worse than was actually the case. Criticism of the wasteful insurance system provides a good illustration of this point for, as we have seen, the profligate companies actually held only a small portion of the insurance market. Nevertheless, belief, even if mistaken, may be a powerful force for political change. It took the Second World War, however, to convert long-standing dissatisfaction with workmen' s compensation into a coherent programme of reform. As a result of the national priorities generated by warfare, namely social solidarity and the promise of a better future following the national sacrifice, the replacement of the workmen' s compensation scheme by an alternative based more upon co-operation than conflict ultimately became imperative. In these circumstances workmen's compensation was scheduled for abolition - first by Beveridge - and substitution by a contributory social insurance scheme. It is notable, however, that in this process, which cannot be discussed here, the notion of a preferential system for workers persisted, notwithstanding Beveridge' s initial desire to establish a uniform system, and also notwithstanding the argument - largely accepted in the social insurance reforms of the 1940s - that benefit schemes should have more regard to the needs of recipients rather than the causes of their misfortunes. The main explanation for this is that the trades unions were unwilling to see members lose a right secured some 50 years earlier, while neither Beveridge nor the Coalition or post-war Labour governments were prepared to confront the unions on this issue. u 1. Much of the early part of this paper is based upon P.W.J. Bartrip and S.B. Burman, u u (Clarendon Press, Oxford, 1983). A follow-up study by P.W.J. Bartrip, on the workmen' s compensation system between 1897 and 1948, is in preparation. 2. Statistics for non-fatal accidents are notoriously unreliable and can be misleading. John Benson argues, in respect of coal- mining, that the trade unions massively underestimated the extent of non-fatal injury and that at the end of the nineteenth century more working days were lost through injury than through strikes and lockouts. See J. Benson, 'Note on Non-Fatal Coalmining Accidents' , u, vol. 32 (1976), pp. 20-22. See also P.E.H. Hair, 'Mortality from Violence in British Coal Mines, 1800-50' , u u, 2nd Ser. , vol. XXI (1968) , pp. 545-61. Some of these issues are discussed in chapters 1 and 2 of Bartrip and Burman, u. 3. u (hereafter u) 1942-43 VI, Inter-Departmental Commitee on Social Insurance and Allied Services , Report, p. 41. 4. (1837) 3 M. & W. 1; 3 Murph. & H. 305; L.J. 7 Ex. 42; 1 Jur. 987. 5. u, 22 July 1836. 6. See: T. Ingman, 'The Origin and Development up to 1899 of the Employer' s Duty at Common Law to take Reasonable Care for the Safety of his Employee ' , unpublished Ph.D. thesis, Council for National Academic Awards, 1972. 7. See Harold Perkin, u u (Routledge and Kegan Paul, London, 1969). 8. National Register of Archives, Broadland Mss. , Shaftesbury Diaries, SHA/PD/2: 24 Aug. , 16 Sept. 1840. See u 1841 X, Report of Inspector Howell, pp. 167-69; Bartrip and Burman, u u, p. 20 and 25-28. 9. See D. Duman, 'The judges of England 1730-1875: A Social, Economic and Institutional History' , unpublished Ph.D. thesis, Johns Hopkins University, 1975; J. Morgan, 'The judiciary of the Superior Courts, 1820-1968: a Sociological Study' , unpublished M.Phil. thesis, University of London, 1974. 10. (1842) 38 Am. Dec. 339; 3 Macq. 316; 4 Met. 49. 11. 5 Ex. 343; 6 Ry. & Can. Cas. 580; 19 L.J. Ex. 296; 15 L.T.O.S. 230; l4 Jur. 837. 12. 11 and 12 Geo. 6 c. 41. In the half century before 1948 the practicability of a defence of common employment had been significantly eroded by legal decisions, notably in u v. Wimborne (1898) 2 Q.B. 401, u v. u. v. u (1938) A.C. 37, as well as legislation, especially the Factory Act, 1937. See A. Russell-Jones, 'Workmen' s Compensation, Common Law Remedies and the Beveridge Report' , u vol. 7 (1944) , pp . 19- 21 . 13. The Law Reform (Contributory Negligence) Act, 1945 (8 & 9 Geo. 6 c. 28) allowed a judge to reduce damages to the extent that he found the claimant to have been responsible for his misfortune. 14. Bartrip and Burman, u, p. 76; u 1873 XIV, Select Committee on the Regulation of Railways (Prevention of Accidents Bill) , Evidence, pp. 587-88. 15. u 1876 IX, 1877 X, Select Committee on Employers Liability for Injuries to their Servants. 16. 43 &44Vict. c. 42. 17. See Bartrip and Burman, u, pp. 158-73; J. & B. Webb, u (Longmans, Green and Co. , London, 1897) , pp. 374-75; T. Ingman, 'The Origin and Development' , p. 165; J. Benson, 'The Compensation of English Coal Miners and their Dependants for Industrial Accidents, 1860-1897' , unpublished Ph.D. thesis, Leeds University, 1974, p. 174. 18. 4 u 8 (20 Feb. 1893) c. 1961. 19. See u 1846 XIII, Select Committee on Railway Labourers, Evidence, pp. 585-89; E. Chadwick, u u by the Want of Proper Regulation of Labourers Engaged in the>u u, 2nd Ser., III (1950) pp. 107-18. 20. See Reort of the TUC Parliamentary Committee ' in u, 1897, p. 22. 21. Workmen's Compensation Act, 1897, 60 & 61 Vict. c. 37. 22. W.C. Mallalieu, 'Joseph Chamberlain and Workmen's Compensation', u, vol. X (1950) p. 57. 23. Throughout this is section statistics are drawn from annual Home Office compilations published as Parliamentary Papers. 24. u u u (HMSO, London, 1929) p. 255. 25. 23 June 1928. 26. Public Record Office (PRO) PIN 12/101. Evidence of W.H. Thompson to Departmental Committee on Alternative Remedies, 28 Feb. 1945, p. 32. 27. Nuffield Social Reconstruction Survey (NSRS), Box 202 [1983], dated June 1942, on Workmen's Compensation, p. 5. 28. In the original legislation compensation was to be calculated entirely by reference to previous earnings. The 1923 Amendment Act introduced small supplements in fatal cases where dependants aged less than 15 were involved. This idea was extended during World War II when widows' benefits were introduced. 29. NSRS, Box 202, dated June 1942, on Workmen's Compensation, p. 9. 30. The original Act gave workmen's compensation beneficiaries first claim on the assets of an insolvent employer. In order to exclude insecure companies from undertaking workmen' s compensation business, the Employers' Liability Insurance Companies Act, 1907 (7 Edw. VII c. 46) required companies, with some exceptions, to deposit $20,000 with the Board of Trade. Compulsory insurance in the coal trade dated from 1934 (24 & 25 Geo. V c. 23). 31. A. Parsons and A. Bertram, u u, 2nd ed. (William Clowes, London, 1902) p. v. 32. u v. u [1901] A.C. 63. 33. A.H.Ruegg, u u (William Clowes, London, 1902) P. 151. 34. [1911] A.C. 410. 35. See, for example, Sir A. Wilson and H. Levy, u (2 vols. , London, 1939) , I, p. xiv; G. Howell, u, u (2 vols. , T. Fisher Unwin, London, 1905 edn.), vol. 2, p. 432; V.R. Aronson, u u (London, 1909), p. 17; u 3 Dec. 1898; u, 4 Oct. 1898 and 24 July 1899. 36. 'Industrial Law', u, vol. 51 (Jan. 1935) pp. 197-98; see also his 'Industrial relations and the State: A Reform of Workmen's Compensation', u, vol. 1 (1930) pp. 511-30, and W.A. Robson (ed.), u (George Allen and Unwin, London, 1943) p. 13. 37. S.H. Noakes, u u (Butterworth & Co., London, 1933). 38. See, for example, u 1902, XCVII, Statistics of the Proceedings in County Courts in England and Wales under the Workmen's Compensation Act, 1897 . . . During the Year 1900, p. 621. Others also took this line, see PRO PIN 12/1, Report of His Honour judge W.C. Smyly to the Home Office, 16 Jan. 1904; u 1904, LXXXVIII, Departmental Committee Appointed to Inquire into the Law Relating to Compensation for Injuries to Workmen, Report, p.763. 39. According to the Beveridge Report workmen's compensation litigation generated 'legal expenses on a scale exceeding that of the other forms of social security in this country, or of compensation for industrial accident or disease in other countries'. u 1942-3, VI, Report of the Inter-Departmental Committee on Social Insurance and Allied Services, pp. 154-56. 40. PP 1932-3, XXVI, Statistics . . . 1931, p. 1019-20; u 1933-4, XXVI, Statistics ... 1933, pp. 1271-72. See 5 u, vol. 235 (27 Feb. 1930) cc. 2393-4; vol. 268 (6 July 1932) cc. 473-6; vol. 270 (15 Nov. 1932) cc. 953-4; vol. 286 (2 March 1934) c. 1432. 41. Workmen's Compensation (Coal Mines) Act, 1934, 24 & 25 Geo. V c. 23. 42. See, for example, 5 u 212 (20 May 1936) cc. 1197-8. 43. u 1920, XXVI, Departmental Committee on Workmen's Compensation, Report, pp. 13-16. 44. PRO PIN 11/7, dated 3 Jan. 1922. 45. u 1923, XIX, Undertaking Given by the AOA on behalf of its Constituent Insurance Office for the Purpose of Limiting the Charges to Employers in Respect of Employers' Liability Insurance, pp. 555-58; see also u, 16 June 1923; PRO 11/5, Workmen's Compensation (No. 2) Bill 1923, undated (date stamped 14 Dec. 1923) and unsigned memorandum from the Home Secretary to the Cabinet; u, p. 256. 46. 16 June 1923. 47. 'Industrial Law' , p. 198; see also Robson, 'Industrial Relations', pp. 511-30; E.H. Downey, u (Macmillan, New York, 1924) p. 100. 48. Beveridge Papers (British Library of Economic and Political Science) , BP VIII 32, 'Further Thoughts on Workmen's Compensation', 17 July 1942. See Jose Harris, u (Clarendon Press, Oxford, 1977) p. 400. Beveridge's ambivalence about insurance is evident in the Social Insurance Committee's report when he managed to list it as both an advantage and disadvantage of workmen' s compensation. 49. u 1920, XVI, Department Committee on Workmen's Compensation, Report, p. 67. 50. u 1904, LXXXVIII, Departmental Committee Appointed to Inquire into the Law Relating to Compensation for Injuries to Workmen, Report, p. 749. 51. u 1942-3, VI, Report of the Inter-Departmental Committee on Social Insurance and Allied Services, pp. 153-54; see BP VIII 32, undated and unsigned memorandum entitled Workmen's Compensation - Present Position. 52. u 1943-4, VIII, Workmen's Compensation. Proposal for an Industrial Injury Scheme, p. 532. What is an Accident? Karl Figlio u The idea of an accident seems straightforward. It is an unforeseen event which is also expected; in this sense, it conforms to our notions of natural law and fits a pattern- The number and the kinds of accidents show regularities, but the moment of any one accident remains unknown, although it is often retrospectively 'predictable'. In the same way, modern medicine sees illnesses as accident-like events; the specific aetiology of disease treats the overall burden of illness as a regular feature of a society, hut interprets any single episode of illness in terms of a pathological injury, say, by germs. The purpose of my paper is to make this commonsense notion historical. So deeply rooted in our cosmology as an ordinary accident may be, it remains a feature of a historically constituted way of understanding events. The notion of an accident arose along with the dominance of contract-based social relations and the settlement of disputes in those relationships on the basis of contract ideas. In particular, I shall deal with occupational accidents in the context of employment contracts, whether explicit or assumed. An occupational injury or illness was an accident at work, and, therefore, could be formulated as a distinct event only when employment contracts became the dominant model of the social relations of work. That was a feature mainly of the l9th century, though clearly it had been developing over a long period. Most of my material comes from claims for compensation under either common law or the statute law of the Employers' Liability and Workmen's Compensation Acts of the late l9th and early 2Oth centuries, which sought to clarify and specify certain aspects of common law. Medico-legal adjudication laid down a framework and an everyday practice within which an event could be seen to be accidental; more strongly, it articulated or perhaps even postulated the notion that nature worked in such a way as to produce expected, yet unforeseen events which happened without any apparent cause. I see this possibility contained within the contract-form; in particular I see the contract-form constituting the notion of an event which ' just happens' . The contract lays down a set of expected events, both by explicit formulation and by implication: it establishes a field of events which are natural, a background in which things occur. This field of natural expectation is often invaded by (retrospectively) predictable but unforeseen events which can be treated routinely in the form of claims for compensation. No fault is assumed, in the sense of malice, yet one party is held accountable, u he or she were responsible. It endorses a notion of causation as a contiguous set of events leading back to a moment when someone was responsible, not by intending to injure but simply by virtue of unfulfilled terms of agreement. Motive is there, but in a neutralised form; accountability without culpability. This field of neutralised intention is the foundation of the belief in 'natural' events ; and the things which happen within the purview of contract, but outside the terms of implied agreement - the natural invasions into the field of natural events - are accidents. u The Worken's Compensation Act of 1897 established a procedure to pay compensation to injured workmen as a routine matter, if they suffered an 'injury arising out of and in the course of employment' - Within strictures on the definition of injury at work, the Act replaced litigation by administration. The workman no longer had to prove employer liability; nor could the workman be deprived of compensation for other than 'serious and wilful misconduct' - The Workmen's Compensation Act of 1906 extended the 1897 Act to a large number of previously excluded occupations, and included a small number of specified diseases which were to be treated 'as if' they were injuries under the 1897 Act. So, by the early 1900's, injuries and some diseases routinely entered employment statistics as unexceptional events to which no liability attached; they simply happened (1). Before the Workmen's Compensation Act, the injured workman could still make use of the Employers' Liability Act of 1880, of common law and, if malice were involved, of criminal law. In every instance, the worker had to show that the employer had been responsible for the injury. To prove liability was to demonstrate that the injury did not just happen; it was caused, no matter how indirectly, by the employer. The Employers' Liability Act simplified the demonstration of employer responsibility, but liability still had to be proven. Unlike the relationship between two parties of equal status, the relationship with respect to compensation for injury between employer and employee was skewed in the employer's favour. Suits against employers under common law were rare during the 19th century (2). Foster has argued that the employer/employee relationship was employment or service 'at will', which meant that the employer agreed to pay for work just completed, on a minute-to-minute basis. The employer therefore accepted no responsibility for the worker beyond the moment and beyond paying for what he had in hand from the worker (3). Foster does not include employer liability for injury in his study, but one can derive from it further evidence of the difficulty in establishing contractual agreements on responsibility for injuries at work. The Worknen's Compensation Act of l897 put aside this requirement to demonstrate liability. One can analyse the shift from accountability to routine happenings at several levels. Elsewhere in this volume, Peter Bartrip describes the l897 Act as very much a compromise issue, and he points out that the conversion from litigation to administration hardly did away with court proceedings. It also left the trade unions worried that there remained little incentive for employers to improve safety standards. What concerns me here, however, is the principle made explicit by the Workmen's Compensation Act that an injury could occur which was nobody's responsibility, but which fell to the employer to compensate, because it arose 'out of and the course of employment' . The injury - or the disease - became an accident. If we put labour law to one side, we see that there was a long tradition of obtaining compensation through civil actions for injury resulting from unintended actions. A compensatable accident could, for example, arise from unexpected consequences of actions agreed between contracting parties. At least as far back as the l4th century, common law provided for redress against a doctor who was taken to have breached his contract by not curing a patient (4). Such a remedy is less surprising in the light of recent research by Margaret Pelling, which shows the inextricable interlocking of medical service and medical trade in the early modern period, so that a material product was often involved in the contract between doctor and patient (5) . The early cases of breach of contract by not curing were actionable as 'negligent misconduct after an undertaking'. It was a borderline area, acting outside the intended range of actions, in such a way as to ham someone of equal status - someone who could be party to a contract, and who could bring a claim for compensation for a breach of the contract. As I have indicated, an employee (servant) was rarely in the position of an equal party to a contract with an employer (master). Because of this inequality, liability for a servant's actions reached back from servant as instrument to master as actor. A claim could also arise from injury to a servant, but an action for depriving a master of his employee's services. In these cases, although the servant was the physically injured party, the master remained the legally injured party. The legal relationship and the grounds to bring an action existed between the two masters. In discussing actions arising in the context of master and servant, u for the early l9th century refer only to this sort of case (6). The concept of an accident was foreign to such a master/servant relationship. Even in relations between equals, when a contracted set of actions, agreed by consenting parties, had an unexpected outcome or ancilliary consequences, the claim lay in showing misconduct u. (7). Malfeasance still presupposed an act, albeit wrongful or negligent; and the legal relationship between super- and subordinate - as in master and servant - included the subordinate's acts within the superordinate' s liability. Thus, every act implied responsibility. Society was a space dense with responsibility and liability. My argument is that the growing prominance of contract relationships and contract law, mainly from the 16th century for the general case, and the 19th century for master/servant relationships, established the possibility of an accident. During the 16th century, the legal formalism for establishing the terms of contract and its breach - u - began to apply to cases of not doing (nonfeasance), as well as to u (8). The simple failure to fulfil a contract could deprive another person of the opportunity to realise a profit; not doing could therefore do harm, and negligence became a form of action (9) Accident could only be formulated in law when a breach of contract by non-feasance became possible. could only exist in a cosmology in which the common view of personal relationships had become contractual, so that obligations and injury could be seen as terms of contract, rather than as motivated acts. Taking occupational accidents in particular, I shall suggest that they could only occur when such relations existed between master and servant. First, I'll sketch the change in cosmology, from a society in which everything had a cause, to a contract society, in which accidents could occur. u When we look at injury and illness in traditional cultures, we are not surprised to find that they are symbolically important indicators of social integrity and disruption (10). That they happen to an individual is less significant than their meaning for the special group. We are less familiar with such symbolism in modern western culture. Recent work on community structure in Germany, however, shows a continuous surveillance of social indebtedness and honour among village families (11). When something occurs in such a setting, either fortune or misfortune, it is expected. Something like that was about to happen and not necessarily to anyone in particular, though ' just deserts ' might frequently be commented upon. An injury, an illness, or some other misfortune, brings relief from the rising community temperature. Nothing could happen by accident, when every event is scrutinized for its place in the dense fabric of expectation. Iegal relations are, of course, more formalised than unwritten community expectation. When something goes wrong, legal procedures make a judgment according to codified procedures. But the procedures build upon common understanding of events, and they allow us to glimpse the social construction of fundamental categories of thought. Coroners' inquests, for example, have been central to the development of a concept of accident (12). The coroner had to establish whether or not a death resulted from malice or from a misfortune to which no intent could be attached. Well into the 19th century coroners' verdicts on occurrences that we would call simply accidental death show a curious mixture of act and accident. Their verdict of 'deodand' singled out from the many unexceptional but sudden deaths a particular kind of event, described in the following way around 1800 (13): "If a horse, or ox, or other animal, of its own motion, kill as well an infant as an adult, or if a cart run over him, they shall in either case be forfeited as deodands; which is grounded upon this additional reason, that such misfortunes are in part owing to the negligence of the owner, and therefore he is properly punished by such forfeiture.' Examples from a series of 19th century verdicts include: trodden by horse, fell from gig, kicked by horse, hit by falling timber. A substantial portion of accidental deaths were classed as deodands (14). The forfeiture of the object 'moving to the death' of the victim - perhaps only a cart-wheel, but sometimes the cart, its contents and the horses - were valued, and the proceeds were distributed among the poor, or given to the lord of the manor, the crown's agents, or the church. Deodand in the routine coroners' proceedings revealed an archaic cosmology, like the village world which I described earlier, contained within modern rational social practices. suggested an accidental, yet curiously intended, occurrence, so that the wrong-doing had to be atoned for, even though the instrument was an animal or an inanimate object. Indeed, deodand verdicts sometimes included explicitly the notion that the instrument of death had acted feloniously; and, as we shall see later, the legal formalism for felony did carry over into liability from breach of contract (15). Coroners' decisions rested on the usual legal refinement of evidence and argument in relation to precedent, and the records of inquests show a well-established routine procedure. For example, one series of inquest records had been sent on to another court for deposit, with a covering note suggesting that the rulings should have been deodand, and not simply accident (16). An 18th century coroners' guide recounted several versions of an apparently often-used precedent for deodand, in which a man drowned in a violent stream while crossing with horses. The author was not convinced that deodand had been the verdict, and therefore doubted that this case could be used as a precedent (17). These routine legal proceedings, with their discrimination of details in the search for the immediate agent, rested ultimately on a belief that things did not just happen. Deodand might therefore be seen as a transitional notion, a category of ambiguous accident, unforeseen and not malicious, yet somehow implying intent. It is reminiscent of the village temperature, in which social debts had accumulated and were discharged through a misfortune. The quotation from Blackstone points up another strand in deodand, again of a transitional sort. Deodand justified punishment on grounds of negligence, as opposed to wrong-doing. One can discern in the category of deodand a shift in cosmology from one in which everything was caused, so that cause in the physical world was equivalent to motive in the human world, to one in which some things just happened. Deodand included both. With negligence as a cause of an accident, the key feature of the modern contract-form of social relations emerged. u could harm, and lead to legal action, just as u was actionable. As an occurrence stripped of intention and wrong-doing, an accident was an event lying outside the explicit and implicit agreements between consenting parties to the contract; it was like a breach of contract. Put in an extreme and stark form, an occupational accident became possible as the relationship between employer and employee became contractual. u Contractual relations between master and servant did not commonly exist, even well into the l9th century; an employee, therefore, did not have the same rights to redress against his or her master as did a stranger. The crucial case was u vs. Fowler (1836) (18), in which an overloaded van, driven by a feIlow worker, injured an employee. The court would not award compensation. With no precedent available, it turned to the general principle that liability must be limited, in order to avoid an extension beyond the employer to, say, the coach-maker. From this ruling grew the doctrine of 'common employment' , according to which an employer remained free of liability for injury caused by negligence of a fellow worker, even if the latter were a manager. Two points stand out: Firstly, the claim failed because an employee did not have the same contractual standing in relation to the employer as a stranger would have had (19); Secondly, the decision lay within the general thrust of contract law, to limit liability and to emphasize consent between the parties (20). The contract u is visible, even in the limitation of contractual equality in the particular case of labour relations. Employment was a form of hiring; if the worker did not properly assess the risks that he took on as part of his contract, then he himself breached the contract by not possessing the skills which he offered for hire (21) . Workers did not have to take unreasonable risks, so, in undertaking a job (as in u), he or she took on the associated risks and the responsibility to judge them (22). The case of u (1874) turned on whether the relationship between the parties was master/servant or bailor/bailee (23). The plaintiff, a cab driver, had hired a cab and horse from the defendant. The horse was fresh from the country, with no experience pulling cabs, and overturned it, injuring the driver. In the original trial, the court awarded the plaintiff fifty pounds, having found their relationship to be bailor/bailee. The defendent then sought to reverse the ruling, arguing that their relationship was master/servant. Although other issues entered into the various appeals, the final verdict affirmed the original decision, mainly by dismissing the appellant's claim to a master/servant relationship with its implication that the cab driver had taken on the risk of the horse's fitness. The limited liability of master for servant was part of instrumental relationship, but it also followed from the growing contract form of relationship. The liberal market ideology expressed the conviction that risks were accepted in return for wages, and that wage rates reflected the degree of risk (24). Adam Smith explained wage differentials on these grounds; in occupations with risks which could not be met with 'courage and address', but were simply unwholesome, wage rates were 'always remarkably high' (25). Indeed, the implied contract of labour with wages in consideration of risk, could even extend to work in which the risk from negligence of other employees was 'so much a natural and necessary consequence of the employment . . . that it must be included in the risks which are to be considered in his wages' (26). This last formulation might be seen as a contract formulation of the doctrine of common employment which, in u was argued from general principles. Just how limited was the liability of master to servant for injuries sustained at work can be appreciated from the statements of the Lord justice of Appeal, William Baliol Brett, giving evidence before the committee on the Employers' Liability Bill in 1876 (27). The committee asked him to comment on liability arising under four headings: (1) intrinsic danger of employment; no remedy for servant (2) defect in plant or machinery; master not liable, unless the defect was both known to the master and unknown to the servant (3) negligence or want of skill of fellow workman; master not liable (4) negligence of workman; master not liable. The Employers' Liability Act (1880) did make two statutory changes in the workman's position at common law. Firstly, it put the workman on the same footing as a stranger, with respect to rights to compensation for injury by a fellow workman; i.e., it abolished the doctrine of common employment. Secondly, the employer no longer had to know of a defect in plant or machinery, in order to be held liable for injury to a workman; he had only to be found negligent in continuing to use it. But equally important, the employer could be liable for not doing something, u for u. With this latter change, we see the esscence of the contractual relationship, which established the possibility of an accident (28). u Negligence lies at the heart of contractual, as opposed to personal, relationships. In the latter, an act of one person may harm another; in the former, failure to act may harm the other. Breach of contract through negligence came into common law in the 16th century. In effect, negligence came into master/servant law only during the 19th century. A promise to act according to an agreed intention establishes the contract, whether or not all the implications of agreement are clear (29). The grounds of a breach of contract also, therefore, not be obvious. Legal proceedings elicit and trace out from the mass of evidence both the intent which grounds the contract and the consequences which follow 'naturally' from breaching the contract. Let us look more closely at the consequences which follow 'naturally' , and therefore become implied terms of contract under common law. In the following case from l854: (30) 1) A flour mill sent a broken mill shaft to the manufacturer by common carrier. 2) The common carrier delivered the shaft late, thereby breaching their contract with the mill. 3) The mill had no spare shaft, so that it had to close down; but the common carrier did know there was no spare. The court allowed breach of contract and compensation, but not the suit for loss of potential profits. It acknowledged a loss, but ruled that the damaged opportunity for profit did not 'arise naturally' from the delayed delivery and that the special circumstance of the mill' s closure was not communicated to the carrier. In this example, we see an interpretation of a contract framing the notions of what is promised in the contract and what events cohere 'naturally', so that they are embedded in the relationship between the parties, even if only by implication. Such a determination was especially difficult in the case of injury or illness, where establishing the consequences 'as would in the ordinary course of things naturally arise from the breach of contract' was complicated by the continually changing state of a person's health, including the effects of his or her own actions. When a railway company conveyed someone to the wrong place, the court allowed compensation for the inconvenience, but not for the illness following walking home in bad weather or for the attendant medical expenses. 'The latter head of damage claimed was disallowed, as being merely connected with a breach of duty by "a series of causes intervening between the immediate consequence of the breach of duty and the damage complained of" ' (31). The restrictions on employees were more severe. Unlike the relationship between bailor and bailee or seller and buyer, the master/servant relationship implied the continuing acceptance of risk. Although a buyer might claim compensation under an assumed warranty for misrepresented goods, a worker was held to have assessed of risks of all sorts, whether of plant, of machinery, of the labour process or of other workers. Whatever the restrictions on liability already contained in the traditions of the master/servant relationship, the contract-form of employment in the l9th century formalised the recognition and acceptance of risk as a natural feature of employment (Volenti principle) (32). For example, although the Employers' Liability Act explicitly did away with the doctrine of common employment, it left the contract form, with the u principle, quite intact. And the contract form included risks arising from actions of fellow workers. The following passages from Addison's classic text on contracts continued to appear even in 1911, long after the implementation of both the Employer's Liability and Workmen's Compensation Acts (33): (A) servant when he engages to serve a master, undertakes as between him and his master, to run all the ordinary risks of service, including the risk of negligence upon the part of a fellow servant, when he is acting in "the discharge of his duty as servant of him who is the common master of both". Thus a worker's injury might inhere in the job, always there as a possibility within the contract of employment. Legal and medical scrutiny focused down on the implied contract, in order to discriminate events which formed a natural cluster within the contract from those that did not. The implied contract and its unintended breach constituted a field of unexceptional occurrences which, therefore, required no particular explanation. In a way which the pre-contract cosmology did not allow, these events just happened. The implied contract and its unintended breach mutually established the notion of 'by nature' and 'by accident'. I shall develop this point further with two examples. Both arose under the Workmen's Compensation Act, but this source of litigation doesn't affect my argument about accidents. Indeed, the Workmen's Compensation Act was built on the principle of accidental injury and accident-like disease. In the first case (1909), a London sewer worker contracted enteritis from sewer gas, which accelerated a long-standing heart disease and consequent incapacity. This progression of events was accepted by the county court judge, but the judge nonetheless ruled against the workman, because enteritis was a risk incident or intrinsic to his job and not an accident. The decision was upheld on appeal. The judge also underlined the interpretation of disease as accident, by pointing out that the legislation to extend coverage of the Act to scheduled diseases treated these few diseases by statute as if they were accidents arising out of and in the course of employment; it did not, therefore, say that they were accidents. The workman's enteritis was neither scheduled, consequently to be accepted as if it were an accident, nor did it breach his contract. Incident to his employment, enteritis fell within an implied contract, according to which master and servant shared the intent to exchange risk for money (34). In the second case (1909), a collier fractured his shoulder at work. The surgeon splinted it and gave him directions for arm exercises. He received compensation, and after two and four months, other surgeons examined him again and gave him further instructions. Eight months after his incapacitation, the collier's shoulder was still stiff. Meanwhile, the company stopped his compensation, on evidence from the surgeons that his continued incapacity resulted from his failure to follow instructions. The court established that the collier was 'of very nervous temperament, and that this constitutional and natural nervousness, intensified to some extent by the accident, was the reason why the applicant did not carry out the directions of the medical men; that this neglect had delayed his recovery, and was the cause of his present inability to work; and that this neglect to obey the instructions was not the result of wilfulness or carelessness, but was due to the nervous condition which he appeared unable to control. 'The judge re-instated his compensation, and this decision was upheld on appeal (35). In this case, as in the first, there was a natural clustering of events; here both physical injury and psychological state combined to cause incapacity. The difference between them lay in the relationship of the naturally occurring events to the implied contract. In the former case, they were implied in the contract; in the latter case, they were not. They were accidents (of the contract) . The idea of 'naturally occurring' comes out of normal common law thinking about both torts and contracts. It requires further elaboration, and I will come back to it. First, let us look in more detail at the demarcation between events implied in a contract and events not implied in a contract. The distinction lay in whether or not a discrete incident could be identified, which happened within the overall purview of the contract, but not within any explicit or implicit acknowledgement of such a possible occurrence by any party to the contract. The pre-existent condition of a worker or of equipment mattered less than any changes in condition within the purview of the contract. A comparison between u (the case of the cab-and-horse hiring) and u u will illustrate this distinction between conditions which breach a contract and those which do not (36) . In u, the plaintiff had hired equipment for a specified period and a specified job. The bailor implicitly agreed to provide equipment appropriate and adequate for the contracted job, and his failure left him liable to compensate the bailee for his injury. In u, a master mariner hired a particular ship. The ship' s boilers needed continual attention, which delayed his voyage. He based his claim for compensation on u, but lost, because the u equipment that he hired had not further deteriorated during the period of the contract. The ship's condition was unexceptional, and no accident occurred. The bailor in u negligently breached his contract; the bailor in u did not. In the collier's case above, he did not abrogate his contract by his nervousness (he had worked), but the colliery did negligently breach the contract (in a statutory way) when the original injury occurred. A similar interpretation applied to a man who left his home, apparently in good health. His work that night was heavier than usual, but no heavier than at some other times. Shortly after work, he collapsed, and later died. Post-mortem examination showed disease of the heart. With no evidence of a particular strain before him, the judge ruled that death resulted from a primary and pre-existent (idiopathic) illness, not from an occupational cause. On appeal (l938), his decision was reversed, with the conclusion that the workman's death had been accelerated by his normal work; and his widow's claim was upheld (37). A similar decision was taken, following a death from an aneurysm while a workman has tightening a nut (1910) (38). This sort of case extended readily to include disease by poisoning or infection, so that when a man employed in handling manure consisting mainly of bone dust suffered fatal blood poisoning, the claim succeeded (39). So too did the claim which set a precedent for the scheduling of occupational diseases under the Workmen's Compensation Act of 1906. In this case (1904), a wool sorter contracted anthrax which, in the court's formulation, was the consequence of a stray gem present in the wool, settling on a sensitive part of his body, such as the eye or a sore (40). Sometimes, no injury could be found. A labourer doing very heavy work received compensation for muscular strain to his chest. He later sought a memorandum of agreement to compensation based on the initial award. The court rejected his claim, using the following arguments: Firstly, his muscular strain was cured; Secondly, he had been suffering from myocardial heart disease throughout the period; Thirdly, every sort of work strained him severely and promoted the disease and Fourthly the disease was progressive by nature, its rate accelerated in proportion to exertion (41). If a supervening event at work, within the purview of contract, occurred, then a new chain of events - a new natural history of injury or disease - began from that moment. The new event entailed a new set of sequelae, all legitimated for compensation by the legitimacy of the new event, which was unimplied, but within the purview of the contract. In this case, an accident occurred, according to the principle of the u u My analysis might suggest that the test to determine whether or not an accident occurred was straightforward. It was certainly easy to state; but more difficult to apply, or to understand the grounds of a particular application. Consider the difference between the following two cases. In the first example, a plate layer had been working in a railway tunnel over a long period, during which time a full railway service operated. His claim, on grounds of anthracosis, a dust disease, presumably from Iocomotive smoke, was rejected (42). In the second case, a girl suffered poisoning from the effects of several cuts sustained at work. Although no single accident caused her incapacity, her claim succeeded (43). The distinction was drawn between the successive impingements of dust, in the first case, and the cumulative effect of accidental cuts, in the second. The first case illustrates a natural history of disease incident to the job, a situation in which the successive exposures to coal dust simply repeated or maintained the background conditions of the job. The second case illustrates an accident with a cumulative impact. Presumably each cut stood out from the background conditions of the job, so that their aggregated effect could be seen as an accident, even though no single cut had any effect and the repetition of minor cuts might have seemed almost normal for the job. Nonetheless, the risk from smoke lay within the implied contract; the cuts did not. u We can see from the examples in the previous section that injury and disease were brought into the same framework. The same test of a breach of the implied contract applied both to a fracture and to coronary heart disease. And none of the statutory regulation of liability over-rode the fundamental feature of contract, the ascertainment of agreement with its implied terms; the hallmark of the labour contract remained the so-called u (u) clause. The u clause meant that the worker accepted the risks inherent in a job as implied tems of contract, by the very fact that labouring for money was a voluntary act - a contract. Such a logic is reminiscent of Marx's ironic use of the term 'free labour' to describe the freedom of a peasantry - converted to a proletariat - to take up work. Yet, free or driven, the worker within a contract-form of employment, entered a working relationship in which the terms of working were carried along in the same momentum towards explicit clarification as they were in other areas of contractual relationships. One judge summed up the u principle (44): 'The principle embodied in the maxim ... has sometimes been stated thus:- A person who is engaged to perform a dangerous operation takes upon himself the risks inherent thereto. To the proposition thus stated there is no difficulty in giving an assent, provided that what is meant by engaging to perform a dangerous operation, and by the risks thereto, be properly defined. ... ' In other words, provided a contract genuinely existed - provided all the items, explicit and implicit, had consent - then the proposition was acceptable. The quotation above shows the continual clarification of the implied contract, in that the nature of u was more carefully defined; agreeing to work could not be taken in itself as evidence of agreement to assume all risks of a job. The contract therefore became more the articulation of an established consensus than a formalism to impose regulation. Of course, for most working people, consensus must have been as ironic a notion as was free labour. Nonetheless the formulation of a relationship as contractual, then of the notion of contractual as consensual, brought a hidden implication clearly to the surface: If the parties agreed to the explicit and implicit terms of their relationship, they had by definition made a contract; if they had not agreed, then they had not made a contract. The contract either existed or it did not. The existence of a contract was a matter of fact. To say the contract was a matter of fact was also to say that it was not a matter of law. The finding of fact displaced the judicial interpretation of the events. The Court of Appeal clarified the factual vs. the interpretive mode of establishing the right to compensation under the Workmen' s Compensation Act in the case of a miner who injured his knee at work (1910). The company had paid compensation for ten months, when they applied for review and termination of payments. Meanwhile the miner had developed asthma which had become the cause of his incapacity. His original injury had occurred on a cold day. During the two hours it took him to get home, he had suffered a chill, followed by chest trouble and pneumonia, and ultimately asthma. In response to the company's application, the county court reduced compensation payments to ld per month, arguing that the miner's condition was not the u result of his injury. The Court of Appeal, however, said that, it was not for the law to judge the natural or probable outcome of an accident, in assessing legitimacy of a claim based on an ensuing disease. The issue was what actually did occur. In this case, what occurred was an accident, followed by debilitation, followed by disease, followed by the incapacity currently before the court. The court of appeal redirected the county court to apply the proper test (45). The classic case which elaborated the notion of an unbroken causal chain was u (1902). A factory worker dropped heavy pipes and injured his toe. Over the following two weeks, he attended a hospital outpatient clinic for treatment, during which time he contracted erysepelas and died. Medical evidence was brought in by the employers to show that he must have infected himself some time after his injury, so that his death could not be considered as as accident of employment; his death, they argued, was not the natural or probable consequence of his injury. The judge laid down the principle that (46): The question whether death resulted from injury resolves itself into an inquiry into the chain of causation. If the chain of causation is broken by a novus actus interveniens, so that the old cause goes and a new one is substituted for it, that is a new act which gives a fresh origin to the after-consequences. If the chain was unbroken, then the question of natural or probable consequences does not arise. The Workmen's Compensation Act specified that an injury occurring at work qualified for compensation and automatically became the first link in a causal chain. That specification simply did away with the requirement under common law, that the implied tems of contract be elucidated, in order to discover if the injuring event were a breach of contract. The same principle, therefore, operated in both cases, with the Act simplifying by statute the exploration of the terms of contract, once it was established that the accident occurred at work. Nonetheless, there was some discussion in u. Clare, as to whether or not the workman caused his own infection - by unwise action, i.e., whether or not he could be held responsible (The case of the collier was similar; ref. 35). In the end the decision based on the unbroken chain rested on an interpretation of the Workmen's Compensation Act. The discussion of the worker's actions, however, shows the traces of contract thinking which, in turn, overlaps notions of tort or wrong-doing. All three legal areas show the attempt to delineate what follows on naturally from an action, either intended or attributable. The residual sorting out of the distinctions between tort and contract in the early 20th century highlights the ambiguity which the case of deodand illustrated for the early modern period. Addison on torts clarified the two areas this way (47): The general rule of law is, that whoever does an illegal or wrongful act is answerable for all the consequences that ensue in the ordinary and natural course of events, though those consequences be immediately and directly brought about by the intervening agency of others, provided the intervening agents were set in motion by the primary wrong-doer, or provided their acts were the necessary or legal and natural consequence of the original wrongful act. In the case of contract, the implicit agreements of the contract would specify the natural consequences; in the case of employment statute law, the confirmation that an act occurred at work sets in motion a causal chain. In all three cases, there is an actual or stipulated responsible agent. Thus, in many cases of injury, the immediate agent or responsible party to the injury was by-passed, and the claim for compensation extended back to the original agent, as the bearer of overall responsibility. So it was, that a man who let water run down the street, not realising that the sewer was blocked, was not held responsible for the injury to a horse who slipped on the accumulated frozen water around the corner (48); but local commissioners whose defective sluice gates flooded properties and, due to defensive reactions by the property owners, flooded the plaintif's property, were held responsible (49). The stopped drain was the original offending act in the first case, and the flooding water in the second case. In u, and in cases in general, where the actions taken by the workmen were set in motion by the original injury, then their enchained actions remain part of the natural cluster of events, whether or not they appear to follow on from the initial injury, and the initially responsible person remained responsible for all that follows. In this sense, the judges working within the Workmen's Compensation Act were within the tradition of contract law, when they refused to allow the question of natural consequences. The workmen's actions taken in response to injury were within the umbrella of responsibility within the implied contract. The principle of Workmen's Compensation therefore, was the same as the grounding of contract in consensus. The consensus and its consequences became matters of fact, not of interpretation. That was the principle, and it was consistent with the two aspects of the trial; the judge dealt with matters of law, while the jury dealt with matters of fact. The appeal in the miner's case above (35) rested on a mistaken point of law (the county court judge's opinion on the natural outcome of injury), so that the determination of fact had been over-ridden. In an earlier example, the case of the hiring of a cab and horse, the appeal went first to a 'court of errors', whose job it was to establish the existence and nature of the contract between the two parties. Although later clarification was still necessary, the principle remained that the fact of the contract contained the resolution of the dispute. Natural clusters of events - events which were causally related - reappeared as contiguous events, either expected or not expected in the contract. A chain of causality which would explain a phenomenon in terms of causal antecedents was reconstituted as a chain of contiguity - a sequence of things occurring within a specified geographical field of application, such as a location. Explanation became an accounting of what did happen, not of hidden causes or of judgments about the nature of things. The idea of getting an account of the facts, from which a resolution would emerge, suggests a legal positivism, corresponding broadly to a positivist epistemology (50). The mass of legal precedents and unending attempts to resolve disputes testify to the complexity of human affairs, but they also show a general movement towards a view of nature as aggregates of events. The emergence of a contract-form of human relationships and especially the notion of u which has been central to it, have helped to form such a view of nature. In other words, the medico-legal machinery represents a massive and cumulative construction of a perception of nature, hidden within the continual practical attempts to resolve disputes. u and Injury The facticity embodied in the contract-form, with its legal framework for interpreting events in terms of an ultimate, responsible act, setting in motion a chain of 'naturally arising' sequelae, polarised the world-view into two domains: wilful acts and natural facts. The fact of consensus in both explicit and implicit terms of contract drove forward the sense of facticity, and informed a perception of the world as a field of joint endeavour, in which intended actions took place against a background of indifferent events. The social and natural worlds, together having been dense with intention and motive, split into a limited arena of 'voluntary' actions in society and a field of events stripped of intention in nature; now there were foci of contractual relationships enacted against a background of phenomena from which public scrutiny for meaning (as seen in the village examples) had been withdrawn. Outside the foci of contract, in the background as the field itself, things could just happen. An accident could occur (51). I have argued that the contract-form, and especially the notion of nonfeasance, with its implication that not doing anything could be an action, helped to form such a cosmology. Nature as an aggregate of events, rather than of intentions, fits with contractual social relations in which eliciting the implicit agreement in a joint venture turned on discriminating sets of contiguous events which stood inside the contract from those which stood outside the contract. In either case, we are talking of 'facts' . If a venture went wrong for one of the parties, the crucial question was whether or not there existed an event within the purview of the contract, but not implied by it, from which a series of contiguous occurrences followed, and led to the damage suffered. Breach of contract by nonfeasance established a field of neutralized intention; in place of actions came events which just happened. In this cosmology, diseases were also accidents. They were the outcome of a contiguous series of events, set in motion at a discrete time and place. Within the accident mentality, illnesses signified breached contracts. Occupations exposed workers to discrete hazards which could set off a series of contiguously related events. The job was one site at which a contract was honoured or breached; social life was another, and personal life yet another. In this cosmology, life was the aggregate of sites at which discrete processes took place, like exposure to chemicals or to cigarettes or even to inactivity and saturated fats. The Workmen's Compensation Act was rooted in such an accident mentality, even in the case of scheduled occupational diseases. The schedule lists diseases, considered as if they were accidents of employment, i.e. as conditions for which statute put aside the normal elucidation of the implied contract. They were not to be seen as precedents for treating other diseases as occupationally caused. By administrative decree, they were accidents, in spite of being accepted as part of (the nature of) the job. The schedule was divided into two parts ; for each disease listed in the left column there corresponded a work process in the right column. Each disease, therefore, was tied to a specific situation; the occupational disease was an event constituted in the correlation of two happenings. At one moment, a pathogenic occurrence set a pathological process in motion. The Dangerous Trades Committee, set up by the Factory Act of 1895, had already reported on several specific hazards, and required notification of diseases scheduled under the Act. Indeed, four of the six diseases originally scheduled by the Workmen's Compensation Act of 1906 had already been scheduled by the Dangerous Trades Committee. Phosphorous, arsenic and mercury poisoning fit easily into the model of an accident-event; and the fourth (anthrax) unambiguously a disease, was construed as an accident (a 'poisoning' by infectious germs) within normal common-law litigation (52). The procedure for scheduling a disease under the Workmen's Compensation Act is clear in the following example. Shortly after the original six diseases were scheduled, the committee on compensation added telegraphists' cramp, and turned down 'twisters cramp' (Dupuytren's contraction). Telegraphists' cramp was listed with little controversy. Testimony supported the characterisation of a very particular condition which developed from hand movements specific to using the telegraph key. There was no question of confusing it with fatigue or with neurasthenia, because it could be detected, not by a general wearing down, but by certain forms of errors in code sending. Telegraphist's cramp, therefore, was clinically specific, differentially diagnosable and attributable to the specific work process listed on the schedule (53). Twisters' cramp in lace makers was not listed until 1921. Although there was plenty of evidence that lace makers suffered from incapacitation caused by the rigid contracture of their fingers against the palms of their hands, there was also evidence that women in the same area, but not employed in lace making, suffered the same incapacity. Twisters' cramp, therefore, could not be attributed only to the specific work process for which it would have been scheduled. Here was an early example of epidemiological specification of occupational illness, such as one finds routinely in later work (54). Whether as a scheduled disease, or as a disease compensated, but not scheduled under the Act or as a disease compensated under common law as a breach of implied contract, the relationship of a disease to occupation was extrinsic; the legal framework constituted disease processes as sets of 'facts' linked by their sequential occurrence. Gill Burke's paper illustrated this way of thinking, in the dominance of the physical theory of phthisis over a more subtle theory of tissue pathology. This restricted view of nature as an aggregate of accidents, however, also brought together heretofore unrelatable events, including many occupational illnesses, now seen as matters of fact and made legitimate by the contract form. The same contract form which confined the sense of nature to that of contiguity, constituted the notion of accident and threw phenomena into causal relationships that did not previously exist. Countless decisions under Workmen's Compensation linked together illnesses which would not otherwise have been seen to be 'naturally' related. The accident model of illness also encouraged legislation to control dangerous conditions in factories. It forced home the recognition that production processes were hazardous, in ways which could be analysed and corrected, under threat of penalty. Thomas Arlidge, chairman of the Association of Factory Medical Officers and later Chief Factory Inspector complained of the failure of doctors to associate specific diseases with specific working conditions. Writing in 1892, he said (55): 'Attention has been directed almost exclusively to those diseases described in medical nosologies, and to the ordinary catalogue of causes, consequently the lesions and sicknesses attending upon employment have been overlooked, or, if recognised, their pathology as not been followed up... In registering cases of sickness and death of patients suffering from the lesions (of lung tissue, arising from textile materials it appears to be seemed sufficient to enter them as examples of bronchitis, or asthma, or consumption, without further investigation.) For Arlidge, an epidemiology which connected pathology with specific working conditions would advance medical knowledge and practice in an essential way. Along with his call for an aetiology, and not just for a nosological description of disease, Arlidge interpreted the relationship between occupation and illness in contract terms. The effect of his contract-formulation of work and illness was to undercut the epidemiology that he proposed. In typical contract terms, the choice of trade, for Arlidge, was voluntary, and higher wages were an inducement for a worker to take on hazardous jobs. The higher wages attracted chiefly 'the reckless, broken-down characters found in the lower strata of society', so that a recklessness of conduct in life and in health matched the hazards of employment. Even where the occupation wasn't particularly injurious to health, it became harmful indirectly, through its associated moral and social environment (56). Arlidge offered up a liberal market ideology applied to health. This is a line which we have followed from Adam Smith to the contract model; one which infomed the accident view of illness, both in medicine and in medico-legal jurisdictions, such as employers, liability and workmen' s compensation. In the end the worker brought along his social and moral character as background features of his work. They became part of nature, along with the risks which were accepted as intrinsic to the labour process. Both natures were written into the implied contract, leaving occupational illness as the accident that suddenly breached the contract. The illnesses of occupations reflected, in part, occupational hazard but also the nature of the social groups that commonly worked the jobs in question. The distribution of illness in society, therefore, reflected the contracting of employer and employee, and all other implied contracts of human relations, whose adjudication came within common law. In some ways, the accident view of illness, and Arlidge's use of it, come close to modern notions. Occupation as the index of social class, also indexes all those features of class-based life which have health consequences. Not just exposure to work-process hazards, but also exposure to class-related geographical hazards, such as environmental pollution, poorer access to health care and generally less healthy conditions, contribute to the class dispersion in ill-health. So do the differences in life chances and the cumulative aggregate of harmful life events. All these aspects of epidemiology, whether of work itself, or of the work-indexed life chances and life events, add up to an aggregate of accident-like events which provides a kind of print-out of the health data of a person's life (57). What the print-out does not portray is health within a life as it has been lived, including the illnesses, forming a single story. The accident model has produced the data, but the person appears only as the ground on which the aggregate of health-data are displayed (58) . The things that happen outside the contract of the moment belong to another contract. A life as an aggregate of contracts loses its biographical continuity, so that it becomes difficult to see an illness as a present state that emerged gradually from the whole of the past. The accident mentality divides each illness experience from every other, in the quest to establish the moment and the setting which would ground (or abrogate) its legitimacy. u What is an accident? At a specifiable moment, an event led to injury or disease; it was an accident - an unforeseen and unintended breach in natural, social and personal history. If it happened at work, it probably lay within the field of the labour contract and its unstated implications, and the question arose as to whether or not the risk was an implied tem of the contract. The contract-form of social relations put nonfeasance on a par with malfeasance, so that doing or intending nothing became a kind of causality, a kind of action. Elucidating the terms of contract determined accountability for injury and illness, and a discovered breach of contract required compensation. The countless instances of legal adjudication of the terms of contract enacted a cosmology within which individual intentions here incorporated as events into lawlike formalised social (contractual) relations. These events could be specified as matters of fact against a background or field in which things could just happen. Even a loss of agreement became a kind of error. In such a field of neutralised intentions, in which things happened by not-doing and appeared as errors among established facts, unforeseen, yet unexceptional, events could occur - as if by nature. Such an event was an accident - a breach of contract. u 1. The classic treatment of workmen's compensation is A. Wilson and H. Levy, u (2 Volumes, Oxford University Press, Oxford, 1935/9. On the political evolution of the Act, see P. Bartrip and S. Burman, u u, u, (Oxford University Press, Oxford, 1983). On medico-legal procedures under the Act, see K. Figlio, 'How Does Illness Mediate Social Relations? Workmen's Compensation and Medico-Legal Practices, 1890-1940' in P. Wright and A. Treacher (eds.) u u (Edinburgh University Press, Edinburgh, 1982), pp. 174-224. 2. Proof of employer liability was difficult, even in the case of violent attack by masters, see T. Forbes, u u This monographi is u u 68, No. 1 (1978), see pp. 35-6. 3. K. Foster, 'The legal Form of Work in the Nineteenth Century: The myth of Contract? paper presented to the Conference 'The History of Law, Labour and Crime', University of Warwick, Sept. 1983. 4. See the historical Introduction by A. Simpson to Cheshire and Fifoot's u 9th edn., by M. Furmston (Butterworth, London, 1976). 5. Pelling, 'Medical Practice in the Early Modern Period: Trade or Profession?' u u No. 32 (1983) 27-30; a fuller version is forthcoming in u 6. u with notes and additions by Edward Austien, 14th edn. (2 vols. London, 1803). 7. There is no entry of 'accident' in Sir Thomas Tomlin, u (2 Vols. London, 1820). E. Umfreeville, u (London, 1761), pp. 4S0ff. does have a section 'Accidents, Casualties, etc. as well on land as by water'. 8. E. Jenks, u 6th edn. (Methuen, London, 1949), pp. 319-20. 9. Simpson, 'Historical Introduction'. 10. J. Comaroff, 'Medicine: Symbol and Ideology', in P. Wright and A. Treacher (eds.) u u pp. 49-68. 11. G. Wilke, 'The Importance of the Perception of Health and Illness for Social Order and Social Conflict', paper presented to the workshop on 'Perception in History and Anthropology: the Problem of "Otherness"', Sponsored by the German Historical Institute, Cumberland Lodge, Windsor Great Park, 22-24 Feb, 1984. 12. On coroners, see T. Forbes, u 13. u Vol. 1, pp. 300-1. T. Forbes, u, p. 7. W. Wescott, 'A Note Upon Deodands', u u 10 (1910), 91-7. u u, 2nd edn (1756). The copy at Cambridge University Library, owned by a local coroner, Charles Martindale, incudes manuscript additions, dealing with specific cases from around l780. 14. Essex County Record Office (ERO), CR/Wl. 15. Forbes u pp. 1-6; ERO, D/DP E188 f39. 16. ERO, CR/S1 17. Umfeeville, u pp. 102-104. 18. Legal cases are enlisted in the following order: litigants, date, volume, standard abbreviation of report series, beginning page. Priestly vs. Fowler (1837) 3M&Wl. 19. E. Jenks A Short History p. 326. 20. Confomity of the doctrine of common employment with the logic of contract law was made explicit in an equivalent case from 1842 in the United States. See L. Friedman and J. Ladinsky, 'Social Change and the Law of Industrial Accidents' , u u 67 (1967) 50-82, esp. pp 54-6. 21. C. Addison u (London, 1847)' p. 745. 22. Ibid, p. 744. 23. 'Bailor' and 'Bailee' refer to the maker and receiver of a bailment; a delivery in trust, based on contract, whether explicit or implied, and for a specific purpose. Fowler vs. Locke (1874) LRl0CP90. 24. Historical Evidence does not support the liberal view. J. Rule, u u (Croom Helm, London, 1981), p. 87. 25. A. Smith, u u (l9776) (Penguin, Harmondsworth, 1974), BR. 1, Ch. 10, Pt. 1. 26. H. Broom, u edn. (London, 1880) p. 79. 27. P.P. 1877, vol. 10, pp. 55 ff; see question no. l9l5. 28. Though in practice, the contract-form restricted the scope of these statutory changes. A scan of compensation cases after 1880 shows this limitation clearly. 29. G. Williams and B. Hepple, u u (Butterworth, London, 1976) . 30. Hadley vs. Baxendale (1854) 9 Exch. 34l. 31. H. Broom, Commentaries pp. 48-9. Broom refers to Hadley vs. Baxendale and to Hobbs vs. London and South Western Railway Co. (1875) L.R.l0Q.B.lll. 32. u: 'That to which a person assents is not esteemed in law an injury. ' H. Broom, u u 3rd edn. (W. Maxwell, London, 18580) pp. 245-54. On u after the Act, see C. Addison u, 2nd edn. (London, 1983). I will discuss u in more detail later. 33. C. Addison, u 9th edn. (l892); similar formulation, llth edn. (l9ll), p. 922. 34. Broderick vs. London County Council (1909) lBWCC2l9. 35. Smith vs. Cord Taton Colliery Co. (l909) 2BWCC121. 36. Robertson vs. Amazon Tug and Lighterage Co. (1881) 7QB598. 37. Moore, vs. Tredegar Iron etc. Co. (1938) 3lBWCC359. These cases are illustrative, and are taken from different 22. periods. They show a trend in thinking, rather than a historical progression. Many cases are summarized in W. Willis and R. Everett, u 36th Edn. (Butterworth, London, 1944). 38. Clover, Clayton and Co. vs. Hughes (1910) AC242. 39. Innes (or Grant) vs. Kynoch (1919) AC765. 40. Turvey vs. Brintons (1904) 1K.B.328; Brintons vs. Turvey (1905) AC230. 41. Miller vs. Carntayne Steel, etc. Co. (1935) SC20. 42. Cole vs. London and North Eastern Railway (1928) 21BWCC87. 43. Selvage vs. Burrell (1921) 1KB55; Burrell vs. Selvage (1921) 14BWCC158. 44. Smith vs. Baker (1891) AC325, see p. 360. 45. Ystradowen Colliery Co. Ltd, vs. Griffiths (1910) 2BWCC357. 46. Dunham vs. Clare (1902) 2KB292 see p. 296. 47. This area is discussed in Sharp vs. Powell (1872) 7CP253 where the quotation from Addison on torts also appears. 48. Ibid. 49. One of several cases discussed in a review of the problems of intervening agents in a chain of liability; Clark vs. Chambers (1878) 3QB327. 50. On ideas of causality in legal thought, H. Hart and A. Honore, u, (Oxford University Press, 1959). 51. Roger Smith has studied the polarisation between will and fact of nature in 19th century medico-legal thought, in the context of psychiatric evidence in criminal trials. Extraordinary criminal acts happened by a loss of will and a submersion in nature, in the form of automation. Trial by Medicine: Insanity and Responsibility in Victorian Trials (Edinburgh University Press, 1981). I have stressed ordinary, rather than exceptional, events; the acceptance of accidents in a natural realm. 52. S. Huzzard, The Role of the Certifying Factory u u, M.A. Dissertation, University of Manchester, 1976. 53. Report of the Departmental Committee on Compensation for Industrial Diseases, 2nd Report, P.P. (1908) XXXV. p. 1, evidence and appendices p. 7 ff. 54. Departmental Committee, P.P. (1913) XVIII, p. 649; evidences and appendices, p. 659 ff. 55. J.T. Arlidge, The Hygiene, u u (Percival, London, 1892). 56. Iid., 21 ff. 57. D. Blane, 'Inequality and Social Class' in D. Patrick and P. Scambler (eds), u (Bailliere and Tindall, London, 1982) pp. 113-24. J. Fox and A. Adelstein, 'Occupational Mortality: Work or Way of Life', u 32 (1978), 73-8. G. Rose and M. Marmot, 'Social Class and Coronary Heart Disease', British Heart journal 45 (1981), 13-19. P. Townsend and N. Davidson, u u (Penguin, Hamondsworth, 1982). 58. For a historical study of a more social understanding of illness, K. Figlio, 'How Does Illness Mediate ...?' For a contemporary social theory of illness, examining biographical accounts of health and illness, P. Freund, u u (Temple University Press, Philadelphia), 1982. u: I would like to thank Ludmille Jordanawa for discussion and criticism, and Michael Lane and Tony Wells for transcribing and translating early coroners' records. This chapter covers the period between the passing of the factory legislation for the u (Reichsgewerbeordnung) in 1869 and the coming into force of the legal accident insurance in 1885. First I will deal with an empirical and descripitive report by the Prussian-German state during the phase of high industrialization. The state aimed to reduce the problem of the risk of reproduction of disease/disability, which became a social problem of Breat importance for the first time, and to see that a satisfactory protection of health for workers was being cared for in the factories. These developments are of interest because the current system of state public health service for workers has in many respects been founded on a Crucial historical decision: the accident insurance law of 1884. At the same time, a concept based on the examples of other states (England, Switzerland), that aimed at a pre- :ventive Protection of workers, was systematically undermined. It is therefore of value to reconstruct decisive factors in this process: i.e. to examine more closely which social poli- tical discussions have preceeded these decisions; how the debate started; which controversies were orginally to the fore; which aspects politics marginalized, or even elimina- ted before a specific conception could be translated into concrete laws and then into social political practice. u The factory legislation of 1869 can be looked upon as a paradigm of liberal capitalist economic legislatoin. It was the starting point for the state Is social measures to protect industrial workers in the u. Its regulations entrusted the form of industrial relations for adult factory workers to a so-called "free agreement" between the factory owner and his workers. There were absolutely no equal rights between the contracting parties. In the harsh reality of industrialization the legislative idea of employment as an object of "free agreement" proved to be a u u for entrepreneurial claims to power, which faced the worker as an octroi of obligatory agreements. In this respect the regulations of the Factory Act of 1869 (Reichsgewerbeordnung) gave the owners a Iegal right which entitled them to create positive law within the sphere of their private property. The state sanctioned a sphere within which the entrepreneur could give the constitution of his factory the organisational form of an autocracy. The employer was freed from public and state interference. The possibili- ties for state intervention were accordingly reduced to a minimum, and were formulated in such a way that effective control could not be expected. These limitations applied to the sole clause for protection of workers which the Factory Act of 1869 contained. $107 stated: "Every factory entrepreneur is obliged to, at his cost the specific kind of the factory and its premises, is necessary for the protection of the workers against any danger to their lives and health."2) This clause was not only a provision which could be interpreted in the broadest possible sense, but also a rule which the authorities hardly ever dared observe. The local police formally functioned as a controling authority, though; their officers were neither competent nor prepared to prescribe anything concerning the regulation of public health, since they had not been instruc- ted to by their superiors. Observance of the legal provision was left to the entrepreneurs; the legally required protec- tion of health depended on each factory's policy as determined by capitalist economic requirements. Government circles became aware the $107 ought not to remain a dead letter when a wave of unprecedently extensive strikes began to affect the German economic life. The resistance, that a movement of close to 100,000 workers offered, was due to labour under capitalist structures fo exploitation that resulted in inhuman pressures at work. Without the social movement of the workers, the knowledge of working conditions would hardly have forced a way out of the carefully guarded sphere of the factory and reached the public sphere, where unhealthy working conditions could no longer be ignored. The Social Democratic Party and trade union movement became more influential in the course of the powerful strike movement, thus obliging the government to act. The beginning of the social political considerations in the Prussian ministerial bureaucracies in 1872 was marked by the realization that the government lacked reliable information on industrial employment. An elementary precondition for legislative initiatives was not there. To remedy this defi- ciency the senior officials in the Prussian ministry of trade supported the endeavours of the u (Association for Social Policy) promoting reforms. The reforming politicians in the Prussian Ministry of State wanted reorganisation of the factory inspectorate. This form of state industrial supervision had existed in Prussia on a voluntary basis since 1854. It only supervised child labour in factories. Subordinate officials were present in only three administrative districts. The inspectorate had become so ineffective that - according to a revision in two ad- ministrative districts in 1872 - even the safety provisions for youth only existed on paper. Extensive reorganisation of the factory inspectorate was planned at the beginning of 1873. An organ was to be created "by which the government first of all could obtain information on the real conditions of the working classes in factories; secondly, by which it supervises the observance of the provisions for the protec- tion of the life, health and welfare of the workers; thirdly by which the government will be informed of everything which the state and the society can and should do to improve the part of the population doing manual work in a physical, eco- nomic, spiritual and moral sense."3) Factory inspectors were to: supervise the regulations issued for the protection and well-being of the factory workers, and to ensure the effectiveness of the regulations. They are to see to a healthy and safe equipment of the workshops, with regard to the de- sign end architecture, and to the working conditions; they are to use their expertise to maintain protection from in- jurious influences of cold, heat, sweat, dust, poisonous material etc., - to the covering of dangerous parts of the machines - gears, levers, shafts, belts etc."4) These of fi- cials were to be responsible both to the government and to public opinion, for initiating reforms. The qualifications, which their duties entailed, demanded above all personal talents as weLl as a senior position within the administra- tion. When these criteria were attained in the ensuing period, the question arose whether the supervision of the factory work of children should be removed from the duties of the factory inspectors and integrated into the field of local police administration, so to leave the factory inspectors more time for industrial hygiene and social statistics. The idea arose of encharging u with the factory in- spection, because "they could take appropriate measures to remedy existing wants because of their inherent experience."5) The efforts which the Prussian Ministry of Trade made in a different field of industrial health policy were neither less far reaching nor less ambitious. In April 1872, after the Ministry had urged the district administrations to finally enforce the regulations of $107 of the 1869 Factory Act through the decree of relevant police orders and not to tolerate the notorious inactivity of the police authorities any longer, it proposed an Act for industrial accident and disease statistics. With the help of standard questionnaires all accidents causing inability to work for at least 8 days and "all diseases caused or intensified by impacts of the different factories"6)were to be reported in every district. Above all, the officials wanted to know in which branches of industry the workers were exposed to the greatest number of dangers, which kinds of accidents were predominant in specific industries and on which conditions a reorganized factory inspection ought to concentrate. In 1873 officials of the Ministry of Trade, accepting proposals by the u u u and by the u, ordered a u u on womens' and children's labour. They strongly re- commended such an inquiry not only to the u, but also exerted a fundamental influence on the formulating of the questionnaire, which for the first time included a section on health. The verdict on the effectiveness of this package of social reform initiatives is as follows: 1. Most administrations thought the decree of police orders for the protection of the workers to be useless. The orders were a dead letter, as the police authorities forgot about them and, as entrepreneurs regarded them as tiresome, they tried to avoid them wherever possible. 2. As to the planned inquiry into occupational diseases the idea had to be dropped, because health insurance schemes, factory doctors and entre- -4- preneurs had boycotted the inquiry. 3. The accident statistics did not make progress, because of opposition from the entrepre- neurs. Minor accidents happened almost daily - as the Chamber of Commerce of Essen noted in 1875 -, and so the factory owners of all these events. 4. Ultimately, the answers to the questions of the u on women's and children's work vividly illustrated on how injuri-ous to health most industries were which employed women. The u also documented an unmistakable scepticism about the effectiveness of a reorganised factory in- spectorate, although the inability of the local police authori- ties concerning the protection of the workers was not denied. It was the government of the most industrialized administrative district of the Prussian monarchy - Dusseldorf - that gave the clearest warnings; they voted for industry which should be able to develop according to its own rationale, and recognized that interventions into its inner organisation would only be tolerated unwillingly if at all."7) The conclusions drawn by the Ministry of Trade from the reports, were, that it was necessary to complete the legal amendments to the 1869 Factory Ordinance, and, to reorganize factory inspection, initially only in Prussia. The way that the latter proposal was put into practice justifies the conclusions that the bureaucra- tic energy to reform had been already dampened by 1874/75 be- cause the high ranking administratiors accepted the reservations of industry against a too rapid extension of the industrial supervision and against the employment of doctors as factory inspectors. From 1874 to 1877 eleven new factory inspectors' posts were created for the whole of the kingdom of Prussia, though they were exclusively for chemists and technicians. As to the powers of the of ficials, their instructions showed clear signs of concessions to the factory owners. Their representatives had suggested that the government organize industrial supervision in such a way that the entrepreneur regarded the factory inspector "as an advising friend. . .but not as an opponent."8) Although the new supervising official was for the first time entrusted with state assistance to enforce $107 of the Factory Act by inspection and instruction of the police authorities, the possi- bilities to intervene were so restricted that in practice he only had an advisory and observing role. The reforming group's socio-political ambitions within the Prussian government were not discouraged by this opposition, and they tried to realize their plans through a legal amendment to the factory legislation. At the end of june 1876 the Prussian Minister of Trade already presented a bill to the u- amt and to the Ministry of State which was based on the reform proposals of 1872/73. It contained not only a number of sharper regulations to protect women and children factory workers, but also included an amended version of $107, as well as the obli- gatory introduction of factory inspectors on the level of the u. (These clauses are given as appendix I of this paper.) Without exaggerating one can say that this Bill was a flight of fancy of state social thinking within the Prussian state's bureaucracy, and a testimony to socio-political principles, that stressed preventive measures. Above all this Bill was the first, state political negation of the liberal axiom of a factory as a non-public, and more or less secret realm beyond the reach of the law. The Bill only provided u for intervention, but these were nevertheless suited for ascertaining information and events, which had been previously hidden from the public power. It was a starting point for an effective industrial pro- tection of health. In fact, the Bill was anything but radical with regard to the principles of capitalist production - as the appendix belonging to it clearly showed; its authors declared that they were concerned only with the "realization of moral principles" in factories as a hitherto isolated part of the social community. The legal regulatons were intended to open the eyes of the entrepreneurs to their duties and, by means of in- dustrial supervision, to convey the idea of the state as opposed to one-sided class interests. These aims were linked to halting the growing influence of Social Democracy.9) To conclude: the Bill could be compared to the factory legis- lation in other industrial states like Switzerland or Great Britain. It could certainly rely on broad Parliamentary agree- ment, particularly since it took into account the demands of the social reformers of the Conservatives, the Progressive Party, the (Catholic) Centre Party and even part of the National Liberals. u The indirect hit at the as yet almost unlimited freedom of the entrepreneurs provoked a protest within the ranks of this class. They succeeded in deciding the fate of the Bill within few months, and thereby in initiating a new course of great importance. The starting point was a critique of the Bill by Alsatian in- dustrialsts, at the request of the u. The in- dustrialists categorically declared that the planned protective regulations exceeded by far anything that the competitiveness of the German industry could bear. Besides the impracticable regulations, the Bill contained a number of highly unnecessary burdens to the employers, as for example, the duty to report an accident. If the proposed regulations gained legal force, they would damage the interests of industry so that it would be un- able to compete and would thus be ruined in the long term. Eight days after this report was sent in a circular to all Prussian Ministers of State, Bismarck took up the criticisms which the industrialists had uttered and wrote: "ln view of the current adverse situation of industry, every legislative action which aggravates production without important reasons seems to be critical. Industry needs a rest to be able to take up the strug- gle against foreign competition again after the recession of the last years. The current point of time is unsuitable for modifications to our legislation, which will disturb the running of the factories or will be disadvantageous to the efficiency of industry at home rather than abroad."10) Almost 'ex cathedra' this new position of the government on workers' protection was announced to the u in the spring of 1877, when the u President, Hofmann, declared that the govern- ment did not intend "to introduce reforms of the trade regu- lations which would interfere with the running of a factory or implement decisive new norms."11) The government was in complete agreement with the economic pressure groups and their parliamenta- ry representation which now carried on a propaganda campaign so as not to lose the confidence of industry through socio-politi- cal experiments. In the course of 1877, Bismarck, after having consulted influen- tial industrialists, sharpened his arguments against the social reform plans of the Ministry of Trade, especially on the issue of public health. He opposed the idea of transferring to the factory inspector the monopoly of definition as to what was necessary to secure the life and health of the workers, according to $107. By doing this the government would create unnecessary enemies among the "influential class of factory owners", because the latter felt justly threatened in their freedom of action. He had no understanding for "why among all branches of human acti- vity it was just with the most difficult and most vulnerable to foreign competition that the protection against dangers threaten- ing human life should be extended to such a degree as in $107." Institutions that serve the health in factories would require such extensive and costly operations "that only rarely and if unusual profit prevailed, entrepreneurs would want them." He concluded: "every new obstacle and artificial restriction in factories reduces the employer's ability to pay wages", and this the state not tolerate.12) This ostentatious withdrawal from the social political conception of prevention in favour of a pretence of securing of jobs was classically formulated in the u speech in 1883 by Theodor Lohmann. He had advocated exactly the contrary ten years before and, despite his better knowledge as an authorized agent of the government, had to declare: "however important the aim of protecting the workers against dangers, the necessity - whatever it may be - remains relative. The aim is by no means one that un- conditionally and under any circumstances had to be and could be reached...it is still more correct to maintain the worker's basis to exist, while he cannot be relieved of certain dangers, than to completely withdraw the basis of his existence."13) The logic of this social principle was that in the years after 1877 the government tried to rigorously reduce all starting points for protection of health for the workers with the help of the tech- nical and managerial proficiency of the associations of the entre- preneurs. Thus it tried to remove the essential barriers to what had become only a token solution to the problem. The first step in this direction was the changing of the factory inspectorate into a state advisory body, responsible for improv- ing the safety of machinery. It reversed the decision by the u in 1878 to turn the inspectorate into an obligatory institution, as it was against the wish of the government. The advisory institute was forbidden to "hinder or damage industry in its appLication of machines and other means and generally in its free development."l4) This reduction of the protection of health to merely technical protection against accidents can be compared to leaving industrial hygiene out of the tasks of in- dustrial supervision. Entrepreneurial organisations similarly prevented the decree of detailed practical regulations concerning the protection of public health in the u trade code. The u had also handed over competence in this sphere to the cabinet (u- u). The influential industrial associations found it easy to convince the government with arguments against preventive measures in this field. They maintained that it was impossible with the current level of technology and with its rapid progress, to make regulations, which were applicable to diverse branches of industries. The consequences of the decree would be manifold disturbances of the factories, disputes with the supervising authorities (which could not be expected to have a full under- standing for the conditions of the different branches of industry) and with the workers, avoidance of necessary precautions and frequent denunciations on the part of the workers, finally, in case of an accident, unjustifiably heavy responsibility of the head of the factory who had not kept to the letter of imprac- ticable regulations. To make every accident in a factory abso- lutely impossible, would mean making the factory itself impos- sible. Factory legislation ought only to protect workers as much as was practicable. The social political policies of the Bismarck government be- came fixed in its principles of 1877. In his programme of 1880 for compulsory social insurance, the law for accident insurance (instituted in 1884) was central. The various bills which the u drafted on this theme in the years from 1881 to 1884 were by no means due to the political genius of the u, but much more a compilation of suggestions which had been under discussion since 1878. This shows how much the government had, when making decisions, to rely on the help of those interest groups, to whom it had felt particularly obliged with its economic and social policy since the end of the 1870s. This can be seen in the central features of the accident law. Accident insurance, the principle of mutuality, and the trade co-operative organisational form had frequently been discussed among the ranks of the entrepreneurs, the private companies of accident insurances, and the supervising officials. They had been presented to the chancellor in an oral and written form, before he had them given the legal form. This also applied to the intention of transferring part of industrial supervision, i.e. the regulations regarding the industrial protection of health, to the trade co-operative associations and thus trans- ferring them into private ownership. In the reasoning behind the Bill of 1884 the corresponding motives were openly laid down. (See appendix II) Bismarck thought of the Bill as having a socially integrative function, in the sense of the state supporting tendencies, which were to secure the participation of independent workers' com- missions in the examination and prevention of accidents. But the Bill did not come into force because of the actions of the lobby of the entrepreneurs. The participation of the workers became a mere decorative appendix to the policy of entrepreneu- rial interests. The industrialists resisted the alleged danger of the workers' commissions that "the subordinate would be organised against his superior" and at the same time would become aware "that his interests collided with those of his master".) The industrialists furthered the principle of a social and health policy, which resulted from economic calcu- lation. For the elimination of the workers' commissions from the accident law did not only mean renouncing the valuable know- ledge of experience, even in the technical sense of accidents which the workers could have added to the realm of prevention of accidents, but also the leaving out of any concept of health risks, moral and hygienic criticisms and those related to basic needs of life. Compared to the material interest of the entre- preneurs for effective prevention of accidents, the action of the u insurance authority under Bo%diker, aiming at extensive measures of preventing accidents, was hardly anything other than a token corrective. A decrease in numbers of accidents in con- nection with this action cannot be proven. Insurance compensation against risk and the simultaneous trans- ferring into private ownership of the prevention of risk, i.e. the transference of the combatting of causes to entrepreneurial private initiatives - this direction of state social policy which started with the insurance against accidents, was the first basic step dividing the combatting of causes (diseases of workers, occupational diseases) from the tasks and terms of reference of state social policy. If one searches for historiacal alternatives to the outlined process of formation of the health-specific part of state social policy, the answer is that there have been no conceptions with regard to the contents which had pointed beyond the state model in 1876. The medical profession did not provide organised faci- lities for worker's health until the end of the 1880s. The doc- tors who dealt with the questions of industrial hygiene and occupational diseases understood their practice mainly in a positivist scientific sense, i.e. as an enrichment of medical knowledge. They mostly renounced any generalization of their isolated observations concerning public health. But even the few doctors who did not shrink from making explicit social poli- tical remarks did not go beyond the demand of moderate additions to the factory legislation as well as successive extension of of industrial supervision. They did not think of any extensive primary prevention. On the fifth annual meeting of the German Association for Public Health in 1877 the main consultant Beyer, when warning of the exaggerated demands concerning public health, emphasized his conviction "that precisely in this field pru- dence and precaution are necessary, and that one should not try to keep up a hygiene which risks or neglects the main priority, the securing of the daily bread. That is why it is necessary to openly and decidedly oppose those immoderate demands which hide behind their pleasant mask of hygienic and humanitarian ends quite different aims. One should not let let emotions reign but considerations and experience." Or, the words of the district doctor Merkel: "hygiene must not emerge as the enemy of in- dustry." 16) It is striking that the demand to employ particu- lar industrial doctors was put forward by social reformers and not by doctors when it was made for the first time in 1891. It is appropriate to conclude with some remarks on the ideas of the protection of workers of the early Social Democrats. They advanced beyond the state reform model of 1876 concerning only the principle of protection, and not concerning the extent and the contents of the protective regulations themselves - the questions of the regulation of working hours or the average working day are not taken into account here - but as to the question of the organisational form of the industrial super- vision. In their draft of 1877 they demanded that the u- u, established shortly before in 1876, should nomi- nate the factory inspectors, because "precisely the professional class represented in the u (Board of Public Health) has on the average retained its political independence and can be characterized by humanity and true, working class philanthropy."l7) As an organisational model the 1885 Bill for "the Protection of Workers intended the establishment of chambers of industry with representation on the principle of parity on the level of the factory as well as the establishment of a labour exchange as a control authority. In other words, the Social Democratic reform proposals basically aimed at a democratization of the industrial u in the form of a participation of the workers, but they did not aim at a fundamental restructur- ing of state social policy in the form of a primary prevention of health risks. At the end of the First World War, a new role was proposed for medicine, a role which arose from the experience of dealing with poisoning and toxic jaundice among shell filling factory workers using tri-nitro-toluene, TNT. An article in the British Medical Journal described the war-time history of jaundice as "an object lesson showing the grounds on which scientific medicine should be based in the future". Observation and experiment, in the laboratory using animals and in medical practice using people, was to be the foundation of the new medicine. "The medicine of the future will attain that perfect advancement and full knowledge which all desire by the association of the physician and the scientific worker, not only in the laboratory, but also at the bedside."s The Health of Munitions Workers Committee and medical staff at the Ministry of Munitions added the factory to the list. The new practice would encompass an alliance between doctors and factory managers grounded in the experience of the war; "The success of the special work of the factory medical service, together with the help given by research during the war ..... opened up a new field for co-operation between medical science and the factory management of the future. "s In this paper we are to examine the response to TNT poisoning among filling factory workers. About 50,000 workers were employed on filling at a time, and 100,000 during the course of the war. The vast majority of them were women. We shall argue that the role of medicine was very far from fulfilling the image of scientific advance outlined above. TNT poisoning, in common with other aspects of munitions production during the war, was the site for a struggle for control. What was unusual was the extent to which medical and managerial interests became clearly combined. The responses to poisoning can be divided into two groups. One, originating with those organising the production of filled shells, included medical, technological and managerial responses. The other comprised trade union action and individual or group responses among those working with TNT. The notion of what TNT poisoning consisted of was articulated through a wide variety of experiences, those of the people who became ill on the one hand, and of the efforts of factory managers and the Ministry of Munitions to organise and control the filling of shells on the other. The medical view of TNT poisoning cannot be separated from the incorporation of factory doctors into the management of filling factories or from a laboratory research programme with the over-riding aim of efficient shell production. Shell filling using TNT was established on a large scale for the first time in the war. Previously, almost all filling had been done at Woolwich Arsenal; a small amount for export was done elsewhere. ST was being introduced to replace other explosives in the pre- war years, partly because it was thought to be less toxic than dinitrobenzene and was less explosive than lyddite. At the beginning of the war filling was carried out almost entirely manually. The work was physically hard, repetitious, and there was a constant danger and fear of explosion. The workers were subject to strict rules of behaviour, in addition to the new systems of management being introduced in munition work in the war. The Ministry of Munitions described the work as particularly suitable for women, as they were not seen as minding its unskilled, monotonous and dead-end nature - it suited their temperament.s The Ministry soon recognised that shell filling was far more dangerous to the workers " health than any other munitions employment, but there was an almost total lack of attention paid to the coincidence of a concentration of women workers with a singularly dangerous task. The connection between TNT and deaths from toxic jaundice reported among filling factory workers in 1915 was quickly made, largely because of similarities with the action of other industrial poisons. Dinitrobenzene, used in the dyeing and explosives industries, had been known to be linked with toxic jaundice for some years, and tetrachlorethane, a constituent of aeroplane dope, was similarly linked with jaundice soon after the beginning of the war. Toxic jaundice was made a notifiable disease as a result of the dope case in january 1916. By this time, public knowledge of the effects of working with TNT was proving a problem for the Ministry. Workers were refusing to take jobs in filling factories, those already employed were becoming "disorganised through fear of contact" and levels of absence from work on grounds of sickness were said to be high.s Some action had to be taken if the production of shells was to be kept up. The result was a combination of managerial and medical solutions to the problem. The Health of Munition Workers Committee, which covered all munition work, issued a memorandum entitled Special Industrial Diseases in February 1916, inc luding a sec tion on TNT poisoning. The Ministry of Munitions produced regulations in September of the same year. Sir George Newman, as Chairman of the Health of Munition Workers Committee, inspected women TNT workers at Woolwich Arsenal in July 1916, and found a high level of illness. 37% of the women experienced what he described as "severe pains below the xiphisternum, associated with loss of appetite, nausea and constipation", and 25% had dermatitis. 36% suffered from depression, 8% from irritability, and 34% experienced some change in menstruation. 5 In the following month, Christopher Addison, then Minister of Munitions, called a meeting of representatives of all departments of the Ministry concerned with TNT, and a TNT Advisory Committee was appointed in October. Members included people from the Medical Research Committee, various sections of the Ministry, the Factory Department of the Home Office, and the Health of Munition Workers Committee. The Advisory Committee produced a new set of regulations in February 1917, and issued recommendations on the duties of factory medical officers, the use of respirators and so on. These were largely based on research set up by the Medical Research Committee, which had begun a series of experiments of the absorbtion of TNT in August 1915. The Advisory Committee discussed reducing the contact between workers and the poison by alternating employment on TNT with so-called clean work, mechanisation of filling, the use of respirators and other protective clothing, and exhaust ventilation of the atmosphere in factories.s It is extremely difficult to estimate the extent to which the recommendations and regulations on work with TNT were actually carried out, or the degree to which they were responsible for the reduction in deaths from TNT poisoning due to toxic jaundice in 1917 and 1918. Certainly the number of deaths did fall - from 52 in 1916 to 44 in 1917 and 10 in 1918 - but it is arguable that this was not the result of the medical attempt to investigate and combat the disease? From 1916 information about the effects of working with TNT were censored in both public newspapers and in the medical press. The results of inquests could only be published in a brief, standard form so that recruitment of labour was not hampered.s The reportings of medical research also had to pass the Press Bureau censorship, and this limitation seems to have passed without objection from the medical profession. The aim was clearly to maintain the state of ignorance in which, according to the Chief Medical Officer of the Ministry, munition workers began TNT work.s Factory doctors and those involved in managing the munitions factories accepted that the prime necessity was to produce shells as efficiently as possible. The effects of this on the nature and direction of the medical investigation of TNT poisoning were clear. Doctors concentrated on distinguishing between symptoms of poisoning which did or did not develop into toxic jaundice and possible death. It was assumed that work with TNT was likely to lead to illness of some degree; the point was to keep those workers whose lives were not endangered filling shells and to remove the early cases of toxic jaundice. However this was by no means a straightforward task. The list of early effects of work on TNT was long; it included drowsiness, frontal headache, eczema, dermatitis, loss of appetite, gastritis, constipation, cyanosis, shortness of breath, vomiting, anaemia, palpitation, yellow or orange staining of the skin and hair, depression and a metallic taste in the mouth. Attempts were made to divide this list into categories, for instance two medical officers working among women filling factory workers suggested in an August 1916 issue of the Lancet that there was one group of irritative symptoms, which may lead, in time, to toxic symptoms. 10 Some of the effects were said to be positively or negatively correlated with the susceptability of the workers to toxic jaundice. Dermatitis was said to be inversely related to poisoning of other kinds, due to variations in the ease of passage of TNT through the skin and into the blood, for instance.s The relationship between "serious" and minor" ef fects remained unclear throughout the war; it was claimed by the Medical Research Committee that the reduction of deaths was evidence of the reduction in illness, and various ratios of one to the other were proposed.s Once the number of deaths had begun to fall, increasing attention was paid to the economic effects of "minor" illness. Linked with this attempt to distinguish between serious and minor symptoms was the belief that certain people "have an idiosyncracy towards toxic absorbtion".s This was the basis for the official guidelines issued by the Ministry of Munitions on TNT work, and many proposals were made by doctors as to the characteristics of the so-called "susceptibles". The latter included the young and the old, those Who had gastric or liver illness, alcoholics, people with syphilis, those who sweated a lot, the malnourished and the over-fatigued - a list which must have included most of the filling factory workers. The ideal aim was to be able to identify and exclude " susceptibles " at a pre-employment screening by the factory doctor, at the same time as establishing that the worker was in an adequately healthy state for the job. However no reliable means of identifying " susceptibles " was found, although eye colour and general health were used. The other function of this inspection was to identify existing illness, not necessarily or even usually for treatment or to exclude the person from work, but often so that the illness could not be used to claim compensation as being caused by TNT.s The factory doctor was supposed to have no curative role. An MRC report published in 1921 concluded that "it has been suggested at different times that alcohol, syphilis, adenoids, obesity and bad feeding are predisposing causes, but no evidence is available pointing in any of these directions".s The Health of Munition Workers Committee agreed but continued to support the importance of some individual characteristic being responsible in the Final Report; "the few affected are not always those who, owing to ill-health or malnutrition might be expected to be especially liable. Industrial conditions, though important, have perhaps less influence than personal idiosyncracy". 1s Once workers had been accepted for munition work, factory doctors , appointed by the Ministry of Munitions, were supposed to carry out regular checks on TNT workers and to withdraw those suffering from poisoning from work. The problem was to differentiate between those who were in danger of becoming " seriously " ill with toxic jaundice, and those who were merely suffering from "minor " ef fects. In September 1916 a TNT "facies" was described, as typical of those who should be removed from work: but peculiar in itself, lips that can hardly be described as cyanosed but of an ashen blue colour, similar gums, and perhaps a faint trace of yellow on the conjunctivae, the rest of the skin showing no icterus."s The same writer later stressed that it was important that the doctor should observe people at work; "The excitement of going to see the doctor - over which at present a great deal of munition time is wasted - tones up the patient and disguises the symptoms. The best way is to steal round the workshops . .."18 The worker's own experience of ill-health had little or no place in the diagnosis of early poisoning. No questions were to be asked. An article in the u in 1916 claimed that even among those already affected, "the history given by a patient is often very misleading. Many of the workers have no idea as to the nature of the substance upon which they are working . . ."19 Medical examinations wasted time which could be devoted to shell filling, some argued, but others stressed their importance in reassuring workers that care was being taken of them. Allied to the problem of the definition of the seriously ill was the exclusion of some effects of TNT from medical consideration at all. The most obvious example was the yellow staining of skin and hair, which was of concern to the people affected but to doctors was simply a sign that the person worked with TNT. The effect on menstruation, mentioned by Hewman early in the war, was not studied in any of the later research. Although it would be impossible (and is probably undesirable) to attempt retrospective diagnosis, it seems quite clear from accounts by women workers that they experienced much more general slight illness than could be suggested by the level of notification of toxic jaundice. Proposed treatments of TNT poisoning if jaundice was not present consisted of some variant of bed rest, a milk diet, and keeping the bowels open. Jaundiced patients were to be given alkali-producing drugs, linseed and mustard poultices for the liver, and rectal and intravenous saline injections. It was generally admitted, however, that the prognosis was poor and that the treatment was not based on any great understanding of the condition. The medical workers said that even if the person survived, their health was likely to be permanently damaged.s The factory medical officers were not only responsible for inspections of workers before and during employment but were also able to advise managers on working techniques from the point of view of health. They were supposed to be seen by workers as being responsible for protecting them against poisoning. The importance of limiting doctors' activities and of ensuring their allegiance to management was recognised by the TNT Advisory Committee at its first meeting, in 1916; "Doctors should be paid by the Factory Managements, otherwise the highest factor in the authority of the Management would be removed". The doctor had to balance losing "a few lives in the manufacture of TNT" with the importance of maintaining the supply of shells. "If 10 percent of the workers at a factory were knocked off because they were susceptible, there would be such a panic that the Factory would probably lose its labour. Of 200 people recently engaged for Perivale Factory, only 21 came in when they found it was a filling factory. Leeds factory was already losing its labour at the rate of 200 a week. (. . .) (Doctors) should work hand in glove with the management, and should not pull a single girl out, except with the consent and approval of the Factory Management. Panic should be stopped by convincing the operatives that the Ministry had "got the thing under control". 21 The doctors' -function was to remove workers who were particularly likely to die, as long as there were not too many of them, and to deal with deaths, post-mortems and compensation. In the latter case the point to reduce payment for 'sunnecspsar's compensation claims by excluding other causes of death at post-mortem, and to give evidence at the inquest "as to the precautions taken in the factory to protect the workers".s There are few records to the details of compensation cases, but in one example which does exist the doctor changed his diagnosis from TNT poisoning to pheumonia once the man had died; a letter to the doctor from the staff superintendent at Chilwell, where the man had worked, suggested that perhaps your certificate (of TNT poisoning) was only tentative. You will readily appreciate of course that we imply no criticism whatever of your care of the patient, but this question of TNT poisoning is one of national importance and that is why we labour this point of diagnosis".s Factory medical officers, therefore, acted as medical administrators governing the passage of workers in and out of contact with TNT, according to certain preconceptions about the nature of the action of TNT and about the relative importance of the health of workers and the production of shells. Their work was supported and informed by more basic research, mainly carried out from August 1915 by a group headed by Dr Benjamin Moore of the Applied Physiology section of the Medical Research Committee. This work was intended to elucidate the route of entry of TNT to the body, and from the start was closely linked with decisions about the use of protective clothing (such as gloves, aprons and boots) , respirators, and exhaust ventilation. Tests for the detection of TNT poisoning were developed, and systems of alternation of employment proposed. This example of the co-ordination of laboratory research with clinical medicine and factory management was coloured by the stress on maintaining output, if necessary, at the cost of the health of the individual. Moore was a major supporter of the theory that individual idiosyncracy lay behind TNT poisoning, and claimed that if enough workers were screened, exposed to TNT and selected according to their reaction, a naturally resistant workforce would result through the "industrial selection of the fittest".s The connection between the scientific research and the development of new techniques of working was close, although the major change from hand-filling to machine filling of shells took place under the impetus of increased production rather than reduced contact between worker and TNT. Medical support for the use of respirators, for example, was privately admitted to rest on dubious evidence but was publicly stressed as part of the workers' own responsibility for protecting themselves from poisoning. A similar alliance of doctors and management lay behind organisational changes in shell filling; alternation of employment on and off TNT work was partly based on Moore's work and could be controlled by factory doctors. It could also be controlled, unofficially, by women themselves, who were for once in a situation where their labour was in demand. Their attitude to their work in general, and their willingness to keep working on filling affected their control over poisoning more than their beliefs about the dangers of TNT. Did munition workers in fact ignore TNT poisoning as an issue? They experienced it in the context of the first mass mobilisation for warfare in Britain Which included women, and their involvement in war work was characterised as ancillary to male fighters. The slogans of recruitment posters added to 'Do Your Bit', the slogan 'Replace a Man for the Front'.s Male munition workers were released for combatant service as soon as they could be replaced by women or boys. Munitions work was perhaps the war work par excellence and this has confused the records of the experience - so much so that there are no adequate contemporary figures for the relative distribution of substituted and diluted* workers since the interests involved in the compilation of such statistics were heavily loaded in defining the nature of the work or the worker - that is whether the work was skilled, semi-skilled or unskilled was subject to such negotiation. It is clear though that the majority of women on THT were working in jobs newly created for war and only extant for the duration, the majority were employed in government filling factories (only operational 1916-1918) and, therefore, on new jobs with largely female workforces, in areas of the country previously unindustrialised. Most TNT workers were apparently new to industry, the majority from domestic service or agriculture (unlike women engineering workers).s They entered a new style of production that had been designed to accommodate inexperienced workers. Reorganisation of the work process involved increasing repetition. Payment systems were devised to keep output high and rising. Piecework and fellowship piecework contributed substantially to increasing the amount and speed of production and therefore the risks in volume use of a highly toxic substance.s The initial protection of women workers was to prevent explosion, and involved clean and dirty sides in workrooms, the donning of overalls, overshoes and caps, the body-searches to prevent forbidden matches or cigarettes entering the factory, the removal of all personal jewellry.s All these had an effect on the worker's consciousness of self and notion of her role as industrial worker, as a unit of production. By 1916, when TNT had become established as the major explosive in British armaments the welfare system had been set up by the Ministry of Munitions which ran the government factories and assisted the management in controlled factories. Welfare was originally aimed at women and the young both for external reasons, their social role and internal, as part of the management of production. The dominant motive was to keep the level of output rising. As the Gretna factory unit welfare supervisor summarised it "the welfare of the women operatives was considered by the Ministry and factory management as second only to the production of cordite".s * A substitute replaces a man directly, doing the sane work. A dilute replaces a skilled man and does the same job but often has the work re-arranged or uses adapted machinery. The worker on TNT found herself with two main agencies through which she could deal with TNT poisoning. One was the welfare system, the other workers' organisations - locally this meant the trade union. Despite the high degree of centralisation in the Ministry of Munitions and the persuasive argument of the official history of the Ministry (that their welfare system was an all covering umbrella for war workers), recent evidence makes plain a wide variety of welfare procedures. In some places the welfare supervisor was well established, highly visible and supported by management - for example, the Royal Arsenal at Woolwich. In others, welfare supervisors were barely tolerated by management, ignored by most workers and unknown to many - for example, Armstrong Wentworth's in Newcastle. They were most effective in government factories where workers lived and worked in the same place - but this is not always true as a contract between North Wales and Gretna shows.s In general welfare systems did not gain support from workers in all their activities - supervision outside the factory was condemned, body- screening resented and education clas ses unattended. Canteens and washrooms were popular as were football clubs, dances and choral societies. The supervision of TNT workers to prevent poisoning seems to have been seen as an activity in which welfare supervisors were interested or responsible - not as an occasion for the self-activity of women workers. TNT poisoning met with very little organised or spontaneous resistance. Why was this? One reason might have been the mutual suspicion of workers' organisations and welfare supervisors. Mary Macarthur, secretary of the National Federation of Women Workers and ex-secretary of the Women's Trade Union League was the leading speaker for women's trade unionism. Her union and other general unions enrolling women grew hugely 1915-1919. She said at a conference on welfare in 1918 that among women workers "there is no word more hated than welfare".s The Health of Munitions Workers' om~mitee issued emphatic instructions to welfare supervisors that they were part of management, not workers' representatives nor suppressors of trade unionism. This could, and did, happen. The Armstrong Whitworth's unit welfare supervisor reported that welfare supervisors "appeared to the workers in the light of spies who were going to watch and report to management . . . or as goody-goody people who were going to poke their noses into the workers' private affairs and interfere with their liberty and independence".s However workers themselves often used the welfare system to express individual grievances. Several welfare supervisors reported excessive dependence by workers, one recorded frequent demands for wage-packet interpretation. Welfare workers at the lowest levels, the supervisors who gave medical checks, and the foremen who supervised the cloakrooms and did body-searches, would have been best place to monitor severe deterioration in individual health. In practice it was left to illness to make the point - welfare workers concerned themselves most closely with good time-keeping. Unexplained absence from work or excess lateness could be caused by illness - and often it was not until the poisoning had made the worker so ill that she felt unable to work that it was detected. Yet other factors in wartime affected women's time-keeping too - badly organised food supplies meant 2 hour queues in 1917; there were shortages of soap and coal so washing was hard; transport was overloaded and slow; there were few childcare facilities. Welfare did provide a rough and ready safety-net for the severely ill - but it did not do so in any consultation with the worker herself. This was a blunt instrument for dealing with TNT poisoning. In its non-specific interest in the worker's health the welfare system reflected the views of women's organisations. The latter distrusted welfare's attempts to replace trade unionism but sought the u generalised protection for women's health as did the philanthropists who had developed welfare before the war. They exchanged personnel - both Isobel Sloan and Madeline Symons moved from the NFWW to goverment service. Trade unionists agitated for the protection of women's health in the interests of their national service - motherhood. A speaker at the 1919 TUC summed up the demand of mother's pensions "If we have got to have an Al nation we must protect the mothers. I honestly believe that the institution of pensions for mothers would go a long way towards checking the race suicide that is now going on".s It is not simply that trade unions did not agitate over industrial disease, or poisoning. Lead poisoning had been the source of disquiet for many years, after a successful campaign it was made notifiable and a special sub-committee of the WTUL had been created to monitor its use and the incidence of poisoning. Lead poisoning was taken very seriously and attempts made in war-time to put women back into lead processes scrutinised.s The only explanation which seems plausible is that lead was known to be not only a killer but a major agent in gynaecological disorder and malfunction in childbearing. It was u not specific to war production. A comparison between lead poisoning cases and TNT demonstrates the difference in severity in cases for women and men. Although of course the history of lead meant that ' case' were more likely to be recognised and recorded while TNT poisoning did not necessarily lead to toxic jaundice. TOXIC JAUNDICE LEAD TOXIC JAUNDICE LEAD u u u u u u u u u u u u u 1916 48 23 122 34 318 20 30 1 1917 45 2 145 42 272 19 45 2 1918 7 2 27 8 124 19 20 0 35 Why did lead, less likely to cause death, lead to intense public agitation while TNT did not? The publications of the women's trade unions were silent on TNT except in 2 individual cases. They did protest about another toxic substance, aeroplane dope, which could cause death by accident through drowsiness as much as through toxic jaundice. In 1917 dope was made safer by removing tetrachlorathane - its most toxic ingredient - from it.s TNT could not thus be rendered harmless . Their representa- tives did use TNT poisoning in argument in discussions at the Ministry of Munitions - but as an example of the increased exploitation of women which meant that they deserved war bonuses or rises in wages. Nationally they did not speak out on TNT poisoning at all - as far as can be seen in trade union press. Locally of course it was different. Again though TNT was used as an example not as a cause - in one incident Addison wrote in his diary: "I had to admonish a deputation from the Federation of Women Workers this afternoon. They have been holding meetings in Coventry. One of their speakers, of an inventive turn of mind, has been giving a lurid account of the dangers of TNT, saying, u u, that all their inside organs would turn yellow and that they would not be able to have children, etc."s When seven girls refused to return to work on amatol (a compound containing TNT) in 1917 they were presented at an industrial tribunal and fined 15 shillings each. sWe are not labour conscripts", they said. The NFWW commented cautiously in the s This fine, and many others for infringements of safety rules, was paid by communcal whip-round. It demonstrates the new self-confidence among women workers, a new articulacy about their rights that was notable in wartime and represented a general refusal to allow militarisation of industry. But women's trade unions owed much of their purchase on govern- ment to their power to discipline their own members. To agitate against TNT in any wholesale way would have been perceived as agitating against women's war work, logically plausible after the pacifist statements of 1914 but technically impossible after 1915 and their acceptance of dilution on terms dictated by the trade unions of skilled men. Oral evidence displays an ambivalent view among workers. Lack of written record should not be taken as lack of concern. The women who were yellow found the yellowing unpleasant. Some cafes would not serve munition workers who added discoloration to the already low status of 'sfactory girl' - they were supposed to be rough and ill-mannered and were instantly detectable. One interview describes officers in a first-class railway carriage looking at her "as if we were insects". Another of her fellow workers said, "They used just to frown on the big factory because we were all yellow you see." s One said very poignantly. "They called us canaries you know, but it wasn't nice like that, it was a horrible sickly green colour. My boys said, they wouldn't kiss me goodnight . . . oh mother, we don't like to see you green."s Yet none of the interviewees recorded fright at the prospect of TNT poisoning, only of accidents. The one worker who suffered any ill-effects from TNT resented not being allowed back on the work.s Another said she'd had TNT poisoning but described work on cordite which she had chewed and had believed had had severe gynaecological effects.s This unconcern may reflect ignorance. The first deaths from TNT were publicised but were few; they could be seen as exceptional and blamed on the individuals concerned. In 1916, when most died, the information was suppressed. By 1917 though, in some factories regular checks were given and each girl hads pint of milk a day which indicated to the workers that government was concerned about the problem, as did discipline over the use of gloves and respirators. One of the women who had refused to work on amatol in 1917 said that she had a further grievance - that she should have been given a mask since "doctors had argued against respirators, gloves and veils for CE work since they resulted in more dermatitis than without".s These women were aware of the correct procedures and that management were not following them - but this perception did not result in any more generalised attempt to convey information to other workers; or an attempt to enlist others in the same cause. Evidence from recent interviews shows much greater fear of accident, particularly explosions, and greater experience of accident. My interview sample had some accidents - two broken legs and one broken arm because of bad lighting and poor workplace safety. One woman saw three severe accidents - one severed arm, one scalping, one crushed hand.44 Accidents are quick, sudden and directly attributable to work, death from toxic jaundice was of ten slow and usually did not occur in public. But TNT was more complex an issue than even this contrast would imply. The dominant notion in assessing perceptions of TNT work was the relation between war work and war service. Mrs Pankhurst changed the name of her march in 1915 which demanded a Women's War Register from the Right to Work march to the Right to Serve march - or so the discussion at the Ministry of Munitions would imply.s Women's work fell into the service category pre-war; women on explosive wore uniform; they enlisted for war service. The deaths from TNT were recorded on a "Roll of Honour" so that death from an industrial disease was translated into a death on active service. s Several interviewees commented spontaneous ly, "We didn't go through what the men did at the Front". They certainly saw then and say now that the odds were very uneven - life expectancy at the Front was 6 weeks for much of 1915 and 1917. The ratio of dead to survivors of men on active military service was 1 to 7.5; while as far as can be calculated 0. 1% of women TNT workers died.s The contrast was extreme and, although not quantified as such, was recognised by women workers and amid the rhetoric of sacrifice it is not surprising that women should have felt that their war service did not put them much at risk. Secondly the war was a temporary phenomenon and so, therefore, seemed the production of TNT. It was a short period in a working life hence it could be controlled by short-term stragegems rather than cured or rendered safe. Women did demand work af ter the war, but not the same work making instruments of death. For example, the prize-winning essay in a factory newsletter said of the writer's war-work; "Only the fact that I am using my life's energy to destroy human souls gets on my nerves. Yet on the other hand, I am doing what I can to bring this horrible affair to an end. But once this war is over, never in creation will I do the same thing again."s 12 Although women's labour was in short supply 1916-1917, for the rest of the war there were enough workers to keep production rising and supply the Front - even if they had to be moved around from job to job. The third reason for lack of any general systematic attempts to prevent TNT poisoning by its victims was that it could be prevented by individual systematic ways of dealing with war production - that is what management and government call labour turnover and absenteeism. The War Register of 1915 had turned all women into potential war-workers reducing a variety of labour histories into a pool of labour. The new factories run by the Ministry of Munitions were based on this source of labour and many women left areas of traditional female employment to work on munitions. Wages were much higher u. Women became more mobile and financially able to cope with short periods of unemployment. Witness after witness to the War Cabinet Committee on Women in Industry bemoaned women's bad time-keeping, lack of commitment in their work and lack of ambition as well as their high rate of turnover. They had an interest in so doing - showing that women were incapable of replacing men - but it is the case that this high mobility was seen as a problem of management.s It was not a problem for the workers themselves. From 1916-1918 women could move freely within factories and between factories - if free of domestic obligations. Since ultimately the only remedy for the build up of toxic material was to avoid taking in more, for the individual woman this was the most effective means of dealing with the problem. Change in the labour market and associated new independence among women were probably the major factors in reducing the incidence of TNT poisoning, as important as medical inspection and policing of the workforce in the interests of production. A fourth factor in dealing with TNT poisoning was the other conditions affecting women's health. Some women's health improved - those on engineering processes or some skilled or clerical jobs in government factories benefitted from higher wages than women earned before and some aspects of welfare. Munitions workers who ate in canteens got subsidised meat rations after 1917; TNT workers got half a pint of milk a day until 1917; simply eating away from home could mean a woman's first chance of eating a proper meal rather than what was left after others had eaten.s The Health of Munitions Workers' Committe'ss reports showed both improved stamina and output from attention to seating, light and lay-put as well as canteens, tea-breaks and medical attention.s The Ministry claimed that milk was ineffective as a specific against TNT poisoning. They dropped the daily half-pint in 1917 since milk was in short supply - but the general state of nutrition may have been improved by the protein intake.s Here the concern for motherhood allied to the need to keep production high and rising did not work unambiguously together. The Medical Research Council could find no u connection between nutritional state and resistance to TNT but felt the general improved level of nutrition among women could be justified as an indirect incentive to war production. It seems quite probab le that more frequent investigation into TNT and its effects had the effect of revealing previously unrecorded conditions among young women in employment - anaemia for example could as equally have been attributed to war conditions as to TNT. The information we have is unreliable becuase of the short-term nature of the interest, the fears for morale and the mobility of the women themselves. The limitations of the state' s know- ledge of women's condition of health are shown by the nature of the discussion on TNT in Britain in 1914 to 1918. Oral evidence would also 13 indicate a high level of deaths from workers who had been on explosives in the post-war influenza epidemic but the relationship needs closer examination to achieve any certainty. The nature of the medical research and accounts of the effects of TNT were deeply affected by the job that the medical profession was being asked to carry out. There was no core of "scientific medicine" which was to attain that "perfect advancement and full knowledge which all desire". Medical knowledge was treated as a distinctly different type of information - its power was used to disarm TNT workers who were faced with factory medical officers, medical inspectors and screening, milk and assurances that the problem was under control. To object to the effects of TNT on their health was made more difficult by censorship of medical and other inform- ation. Munitions workers did respond to TNT poisoning by refusal to do TNT work, by absenteeism and changing jobs - but they did not challenge the medical and scientific explanations. Their actions had to be based on individual experience combined with information and rumour passed by word of mouth. They did thereby succeed in forcing the Ministry of Munitions to protect their labour supply by taking action but beyond that they could act no farther. Their own organisations did not challenge the scientific explanations either despite their inadequacy and were more interested in the general conditions of women as mothers than these sufferers from a specific war-related disease. War provided a vast social laboratory for experiment on occupational disease and enabled doctors to claim TNT as a medical issue. This reduced the possible action of those most affected by the problem; emphasised the limited problem of death rather than the more extensive one of disease - and ensured that the lesson of industrial poisoning and its control should remain restricted to seeing it as a problem of production for doctors , management and the state not a problem for the entire body politic. 13 1. W.H. Willcox, "sLettsonian Lectures onJjaundice: with special reference to types osccurring during the War", u u, 17 May 1919, 708, and Medical Research Council, u, Special Report Series No.58, HMSO, 1921, 5. 2. u, unpublished 1920-4 v para III, 68. 3. lmperial War Museum, Women's Work Collection, Munitions 1 (IWM, Mun) report of the superintendent of HM Cordite Factory, Gretna . 4. Health of Munition Workers Commttee Handbook, uhe u, HMS0, 1917, 97. 5. Sir George Newman, report in Addison papers, box 2 at the Bodician Library, Oxford. 6. Advisory committee minutes , Addison papers, Box 2 and PRO, MUN 4/1732. 7. MRC, 1921, 25. 8. Notice to the Press, 1 Nov. 1916, Addison papers, box 2 TNT Advisory Committee instructions to the Press Bureau, 1916, PRO, MUN 4/1541 9. MRC, 1921, 31. 10. A Livingstone-Leermouth, B.M. Cunningham, "Observations on the effects of tri-nitro-toluene on women workers", u, 12 Aug. 1916, 261. 11. Ministry of Munitions , "Trinitrotoluene Poisoning", u, 16 Dec. 1916, 1027. 12. MRC 1921. 13. Editorial u, 16 Dec. 1916, 1021, and op cit fll, 1026. 14. Dr. W.J. 0'Donovan, "Circular to medical officer in filling factories", 1916, Addison papers, box 2, and R.H. Crummer u no.l (Leeds) National Filling Factory, unpublished n.d. 45. 15. MRC, 1921, 16. 16. Health of Munitions Workers' Committee u u, 1918, Cd 9065, 78. 17. B. Moore, letter writing earlier work, u, 4 Aug. 1917, 164. s MRC (Committee) Special Report Series no.11, u u (TNT) Poisoning, HMSO 1917, 47. 19. Ministry of Munitions, "Trinitrotoluene Poisoning", u 16 Dec. 1916, 844. 20. u, 16 Dec. 1917. 21. Minutes of the TNT Advisory Committee, PRO MuN 4/ 1782. 22. Ministry of Munitions, issues to medical officers in filling factories. 1916, Addison papers, box 2. 23. PRO, MUN 4/4872. 24. MRC 1917, 59. 25. Recruitment posters , IWM. 26. Labour Gazette, Dec. 1917, 438. 27. G.D.H. Cole, u, Oxford, 1923. 28. Health of Munition Workers Committee, Memo no.4, u u pp.1916, xxiii, Cd 8185. 29. IWM. MUN 14, Report from National Shell Factory Groetna, 9. 30. D. Thom. unpub. Ph.D. The Ideology of Women's Work, 1914-1924; with special reference to the NFWW and other trade unions, 1882, CNAA, chap.6. 31. cit B Webb in K. Dewer ed. u, 1920. 32. IWM, MUN 19, Armstrong-Whitworth's 33. The Congress Report, 1919 cit Gr. Braybon, u u, 1981, 199. 34. Women's Trade Union Review. 35. A. Anderson, u, 1922, 307. IWM, MUN s, Roll of Honour (those killed on Munitions Work) this records 76 deaths from TNT poisoning. 36. PRO, MuN 2/27, 16 Sept 1916. 37. Addison diary. Addison papers. 38. u, 16 Feb. 1917 u, March, 1917. 39. IWM Recording. C. Renolds 000566/07, Reel 1. IWM Recording. E. McIntyre 000673/09, Reel 1. 40. Interview Mrs. L. Robinson, July 1977, D. Thom. 15 41. Interview Mrs. MacKenzie, June 1977, D. Thom. 42. Interview Mrs. Cushin, June 1977, D. Thom. 43. cf 38. Interview Mrs. Bennett, July 1977, D. Thom. 45. PRO, M 5.70 11 Aug. 1915, 28 Aug. 1915. 46. IWM, MUN 34s 47. Calculation based on figures from N.B. Dearle, The lost of the War. Newhaven 1924, My thanks to Dr. jay Winter for this reference. 48. IWM, MUN 28, Alexandria Filling Factory. 49. Report of the War Cabinet Committee on Women in Industry, pp. 1919, Cmd 135, and Evidence to the War Cabinet Committee on workmen in Industry,>u Cmd 167. 50. Mrs Pember u, u, 1911, demonstrates income households. 51. Health of Munition Workers Committee Handbook u of Women, 1917. 52. PRO, MUN 2/28, 27 April 1918, 9. "THE GOLDEN FACTORY ". (1) INDUSTRIAL HEALTH AND SCIENTIFIC MANAGEMENT IN AN ITALIAN LIGHT ENGINEERING FIRM. THE MAGNETI MARELLI IN THE FASCIST PERIOD. Milan was an important city in the development of industrial health care since it was there that Luigi Devoto opened the world's first occupational health clinic in 1910. The Clinica del lavoro, which inspired the creation of many others all over the world was founded "to scientifically study the causes of occupational diseases and improve doctors " knowledge of them: to provide in-patient diagnosis and treatment for workers with either suspected or confirmed cases of industrial diseases: to make periodic inspections of the health of industrial workers in general and especially of those who did particularly unhealthy jobs " (2) Devoto's work meant that, in some respects, Italy was a pioneer in occupational medicine . In the field of preventative legislation, however, she lagged behind and insurance against industrial acciden ts did not become compulsory until 20 January 1904 and even once it came into force was ignored by the majority of firms. In 1906, a circular from the Ministry of Agriculture, Industry and Trade noted that the law was "generally respected very little. Men factory inspectors complain the majority of industr- ialists and entrepreneurs reply that they have never even heard of the legislati on".(3) Meanwhile, in larger firms there was a growing interest in accident prevention and in 1894 the Associazione degli indusrialid "Italia per prevenire gli infortu ni was formed. This gathered statistics on accidents, inspected factories and dis- tributed propaganda on accident prevention to industrialist, workers and engineering students. At first, it was very active in its attempts to encourage accident prevention, although its missionary zeal seems to have declined with time.(4) The legislation and the employers initiative were to a certain extent inspired by fear of the strength of the workers movement around the turn of the century. With the seizure of power by the Fascist Party in 1922, the working class movement was crushed and in the next few years free trade unions were replaced by fascist sindicates and the right to strike abolished . The interest in health and safety did not, however , totally disappear and in 1934 new legislation came into force which extended compulsory insurance to cover six industrial diseases : lead, mercury, phosphorous, carbon disulphide and benzol poisoning and anchylosis. 1933 saw the creation of INFAIL (Istituto nazionale fascista per l"assicurazione contro gli infortuni sul lavoro) a state organisation which centralised all the insurance bodies. (5) The rise to power of Mussolini's party did, however, create problems for some members of the medical profession since the destruction of the free trade unions undermined the relationship of cooperation which had begun to evolve betw een certain factory doctors and workers in the pre-fascist period. For Devoto, this was also a difficult time. In some respects, the Clinica del lavoro was a democratic institution as it "represented the acknowledgment of a very import- ant problem, that is the existance of the unequal position in society of one class , the working class " (6)Devoto himself referred to the clinic as "a child of the people " (7) and adopted the motto "equality for all in health, everyone should benefit from the advances of medical science". (8) It is perhaps not surprising, therefore , that "With the advent of Fascism. . .the Clinic . . .fel l under a shadow for a while. . .it was treated with suspicion and regarded as a source of demagogy and the numerous declarations of affection from the working classes seen as compromising. As a result the Clinic was thrown into almost total isolation".(9) In spite of this, the interwar period was not entirely negative in the field of industrial health since, as Luisa Dodi Osnaghi has argued ( 10), th e medical profession was becoming increasingly interested in this question and particularly in the problem of toxicity as the chemical industry was expanding and new processes and materials were being introduced. Certain medical experts were also beginning to look beyond the narrow definition of industrial health which simply saw it in terms of dangers in the workplace. Factory doctors, they stressed, should take a broader view of workers " health and consider both the home and work environments . Despite these advances in medical awareness of occupational health questions, conditions in many industries were very bad. This was to a certain extent due to the particular way in which American management ideas were intro- duced into Italian industry. Henry Ford's mass production of cars and Frederick Taylor's experiments with "scientific management " aroused a great deal of inter est in Italy. Numerous articles appeared in management publications discussing the applicability of these ideas but to implement them necessitated a complete reorganisation of the factory which most firms were not prepared to undertake. Instead, they simply copied a few selected aspects of the American form of management such as the use of piece-work and a faster rate of production. Tech- nological innovation remained limited and wages were low. (11) This implied a whole new range of industrial health problems , but instead of looking for new solutions the contemporary analysis tended to blame the victi ms and in the opinion of many occupational health experts, "with increasing frequen cy workers were inflicting injuries on themselves in order to obtain whatever small compensation the law provided . . .this accusation that injuries were self -inflicted was the subject of a propaganda campaign during the whole [interwar] period , wh ich became even more insistent during the debate about the reform of the 1904 legis- lation". (12) The employers organisation, the Confindustria, for example, claime d in 1930 that only between 8 and 30 per cent of all accidents were caused by mach - inery whereas 70 to 75 per cent could be attributed to the workers themselves. ( 13) The logical conclusion of this was that if workers caused accidents then they should be sacked. Giulio Sapelli argues that many employers did not bother to introduce safety measures since no unions safeguarded the workers interests and he sums up the policy of the majority of firms as the, "Selection and eliminatio n of unhealthy workers and their replacement with younger elements whose health had not yet been impaired by factory work." (14) In one sector at least this seems to be an accurate description of the situation. As a recent study by Bruna Bianchi (15) shows, in the textile industr y health and safety were appalling. This was still a major sector in the Italian economy. In rayon producton, for example, Italy was second only to the U.S.A. and she was the world's largest exporter. Capital investment in new technology was minimal and productivity was raised mainly by increasing the pace of work to an intolerable level. Protective equipment such as ventilators was often lack ing and the workforce, which was largely female, had a high turn-over rate because worn-out workers were often sacked and replaced Conditions in the rayon industry were especially bad and many workers were exposed to toxic carbon disulphide fumes. In these cases, however, those who were sacked quickly were often the lucky ones since in the advanced stages of this poisoning the victims behaved as if they were mad. Many were shut up in mental hospitals despite the fact that medical journals had published research proving the link between exposure to these fumes and symptoms of madness. This method of shutting away the evidence was further facilitated by the fact that many of the victims were women. In the Snia Viscosa factory in Venaria Reale, for example, doctors refused to take the symptoms of young factory girls seriously since they considered that women had "naturally " hysterical temperaments. In another factory the symptoms of an entire shop were dismissed as collective hysteria. Thus all the rayon workers we re vulnerable since no union or right to work protected their interests but the women among them were the most defenceless due to the myth that women were essen tially irrational creatures prone to hysteria . Unfortunately, there is only a very limited amount of comparable research into industrial health in other sectors of Italian industry in the Fascist period. Although a number of important studies of Italian firms have been publis hed, they have tended to ignore the question of industrial health, to a great extent due to the fact that adequate source materials are very scarce on this subject. There is still a need, therefore, for more research into the situation in specific factories . The case of the Magneti Marelli is of special interest although far from typical. The Fabbrica Italiana Magneti Marelli was founded in Milan in 1919 with capital jointly provided by the Turin car manufacturer Fiat and a heavy engineering firm the Ercole Marelli. Initially set up in response to the new market for magnetos created by the expansion of aviation during the First World War, the firm quickly extended its range of products to include numerous electrical parts for cars , aeroplanes and trains as well as radios and military equipment. The rising demand for radios , the links with Fiat and a number of important state orders meant that this firm was in the fairly unusual situation of manufacturing for a steady and expanding market.(16) The autarcky policy (whi ch aimed to make Italy's economy self-sufficient) was also important in its growth since this gave the Magneti Marelli a monopoly on the Italian market for many of its products. Certain Italian firms, such as car manufacturers, were specifically directed by the Fascist government to use Magneti Marelli part s rather than imports. The original small plant which opened in Sesto San Giovanni, an industrial suburb of Milan, was added to and by the Second World Wa r there were four plants in Sesto and Milan alone and a number of others scattered in various parts of Italy. This rapid growth should not, however, be ascribed to secure markets alone since the Magneti Marelli made a serious attempt to introduce fordist and taylorist ideas. The first conveyor belt assembly line, fo r example, was already functioning by 1924. The only other firm with a comparable approach to the organisation of production in this period was Fiat. The Magneti Marelli management, furthermore, took a special interest in "scientific personne l manageaent". This innovative and pioneering approach was also applied to the health and safety policy. The variety and complexity of production of this firm created a huge range of potential health hazards. For example, products such as radios and car parts required dangerous cutting machinery, batteries involved toxic chemicals and the foundry plant presented numerous risks with its furnaces and sandblasting equipment. Despite this, the evidence that has survived (17) of accidents and health problems is largely restricted to workers in the cutting shop who frequently injured their hands and those who contracted silicosis from handling chemicals or working on the sandblasting equipment. The fact that accidents do not seem to have occurred so frequently in other jobs suggests that the health and safety policy may have had some effect. In june 1927, the Magneti Marelli became the first factory in Italy to set up a safety committee. Sapelli (18) argues that whereas these committees fought the industrial accident rate seriously in their country of origin, the USA, in Italy their role was very limited , concentrating on propaganda to educate workers to be more careful and watching out for workers who were unsuitable for their jobs in order to dismiss them. This may have been true in other industries but it would be an over-simplistic assessment of the Magneti Marelli Safety Committee. This consisted of a group of foremen, workers and technical and managerial staff.(19) The factory doctor, the social worker and other representatives of the firm's extensive welfare services were members, although by the 1930s their role seems to have diminished to an advisory one. The Committee worked in cooperation with all sections of the factory including the Organisational Department (responsable for the "scientific organisation of production " ) . The exact composition and structure of this Committee was modified on a number of occasions but two important features remained constant. One was that, althoug h this was ostensibly a mixed committee of workers and managers the workers remain ed essentially subordinate to the management. The other point is that, in a factory where over a third of the workforce was female, the Safety Committee was composed entirely of men with the sole exception of the factory social worker. There is no evidence that a single female member of the workforce participated, in spite of the fact that many accidents occurred in female-designated jobs such as cutting. This meant that, despite appearances, the Safety Committee was not a power-sharing exercise. Yet the workers were not included for simple window-dres sing; they had a role to play. To understand this, we need to look at how the Safety Committee worked. When accidents occurred, the Committee investigated. Sometimes this simply meant collecting a report from the foreman but frequently it entailed carrying out a detailed investigation or even getting the help of the worker to reconstru ct the event. In this way, the Committee gathered statistics on the seriousness and frequency of accidents as well as investigating their causes. Recommendation s Here usually made on the prevention of future accidents , such as the introducti on of protective clothing or shields . In drawing up the report the Committee worke d in cooperation with various technical and managerial departments of the factory . For example , when Adelina Sigurta , a worker in the magnet making shop , cut her finger on a grinder, the Safety Committee made a thorough investigation. Not only was this particular accident taken into consideration but also the records of previous similar cases were examined in the search for a solution. The report concluded that another similar accident could not be prevented in the future by simply installing better protective equipment. The matter was, therefore, referred to the Organisational Department which proposed three solutions. One of these suggestions has unfortunately been lost and the second was simply a mechanical adaption but interestingly, the third proposed an actual alteration of the cycle of the workprocess, so that the order in which certain tasks were carried out was modified. (20) This constitutes a broad and innovative approach to accident prevention. The Committee was also involved in an active propaganda campaign. The workers who were members were important in this since they were drawn from every shop of the factory and could therefore relay new ideas on health and safety to their work companions. A special noticeboard was get up with photographs, stories and advice, featuring slogans such as , "A pay packet is always bigger than injury benefit " (21) or "A word of advice to a workmate costs nothing and can save him from an accident". (22) This also presented statistics and information about accidents that had already happened and accounts of the Safety Commitee's activities. To encourage interest, humorous stories were invented about a fictitious character called u " who had every conceivable form o f accident and competitions were run to find the work team with the lowest acciden t rate. Safety booklets were produced for the workforce and visits were organised to exhibitions . Numerous articles were published in the factory newspaper. One of the aims of this propaganda was to stress how much the firm was doing for the workforce. The articles in the factory newspaper, for example, wer e generally focussed on the u role of the firm in fighting the accident r ate and industrial disease . Less attention was paid to the dangers presented by particular types of machinery except in the context of describing new protective innovations . The management was interested therefore , not only in protecting the workers health, but also in convincing them that their welfare was cared for . The campaign also tried to encourage the workers to participate personally in the fight against industrial accidents by taking greater care during their work, suggesting new ideas for accident prevention or serving on the Safety Committee . Only a tiny fraction of the workforce was illiterate (23) so that the majority of the had access to this propaganda, but it is difficult to assess whether it had any actual effect, although there is some evidence that workers did make suggestions about making machinery more secure. (s) The Magneti Marelli Safety Commitee saw industrial health as a complex issue involving a mixture of technical , organisational, environmental and human factors. The last two were also the concern of the "Psychotechnical " Department, which was another American-inspired innovation . This Department had been created to apply "scientific" techniques to the firm's personnel management . In interwar Italy, there was a certain amount of interest in "psychotechnical" ideas , especially among academics such as Agostino Gemelli (Catholic University of Milan) and Mario Ponzo (University of Turin) . Numerous articles were publish ed in management journals and in November 1932 a free psychotechnical advisory service for industrialists was set up in Rome by ENIOS (Ente nazionale italiano per 1 "organizzazione scientifico del lavoro) , an organisation which had been created by the government to encourage the introduction of scientific management methods in Italy. However, these efforts were largely fruitless and only a handful of firms even attempted to apply these ideas. s With regard to th e vast majority of Italian firms , Sapelli was probably correct when he asserted that, "In spite of the remarkable efforts of men like Agostino Gemelli , there is no evidence of an effective introduction of psychotechnical methods in industry ". s The Magneti Marelli, however, actually set up a special department to introduce these new ideas and as Mario Fossati noted in 1927, in this factory new workers were "for the first time in Italy, scientifically recruited, which means that a worker is only taken on if he fulfils certain requirements and he is assigned to the shop to which he is most suited both mentally and physically ". s Run by the factory doctor, Annibale Correggiari, the Psychotechnical Department contributed to the health and safety campaign in two ways. Firstly, it developed a "rational " method of selecting new employees and, secondly, it studied the work environment to assess which factors might give rise to health problems in the long run. This "rational " selection procedure consisted in a series of tests which each applicant for work had to undergo . Specialised equipment was used such as the Beyne and Bettagne apparatus which measured the speed of reaction to a visual stimulus . The worker tested had to interrupt an electric current as soon as a light became visible . A mechanical pen automatically recorded the speed . Other equipment measured factors such as the level of tiredness experienced by a worker at different stages of the day, the sensitivity to touch of the fingers , physical strength or accuracy in drawing a line exactly half way between two others. s Workers were tested in this way principally to raise output by improving the "quality " of the workforce but this was also seen as a way of preventing accidents since workers were only employed if they could perform a task fast and efficiently enough. The ideal score for each of these tests was determined by testing the existing workforce . The recruitment strategy may have cut the accident rate but it also aroused the suspicions of the workers who feared that it could be used to eliminate the weak, ill or ageing who often desperately needed work. Umberto Quintavalle , one of the directors , specifically tried to refute these allegations in an article in 1928, where he argued that although the psychotechnical test had been criticised as a method of eliminating workers who became ill, it was not actually used in this way but instead ensured that workers were not given jobs too taxing for their capacities. s Evidence from the factory archive does , however, reveal th at the workers fears were not unfounded. In 1933, a memorandum to the u u (managing director) concerning the sacking of a worker notes that, "At the moment the management is reviewing the workforce to eliminate those employees who are the least productive because of their age or temperament and replacing those dismissed with the young and energetic". s This particular worker was sacked simply because he was too old. This testing procedure was aimed at fitting the worker to the needs of machinery and the organisation of the workprocess in contrast to The Magneti MarelIi Safety Committee saw industrial health as a complex issue involving a mixture of technical, organisational, environmental and some of the work of the Safety Committee which modified machinery and the work environment to fit the needs of the workforce. The Psychotechnical Department was also, however, concerned with the environmental causes of acciden ts and industrial diseases. Light, heat and ventilation were all monitored and it was attempted to improve the position in which each worker had to sit or stand . For the measurement of light, for example , a special machine , the "Luxmetro", Has used . A table was drawn up of the number of "Lux " units necess ary for each task and the machine was carried around the factory making checks . (31 ) The work of the Safety Committee and the Psychotechnical Department demonstrate that this firm took the question of industrial health very seriously . It is not easy, however, to evaluate to what extent this campaign was actually successful. The only statistics that we have been able to find show the effects of the accident prevention policy in the first two years after the foundation of the Safety Committee. According to these figures, published in an article by Correggiari in 1930, (32) the accident rate fell substantially in 1927 and 1928 in comparison with 1926. (Table 1). This reduction was not, however, reflected in the amount Table 1 :Number of Accidents per 1000 Hours Worked, 1926 to 1928. ( 1926=100) 1926 100 1927 94 1928 76 Source : A.Correggiari, "La prova dei fatti", Sprazzie Bagliori, gennaio 1930, p 45. of production time lost due to the granting of temporary sick leave following accidents. The number of days wasted in this way remained at roughly the same level during the three years under consideration. Correggiari dismisses these figures as unimportant and maintains that they were most probably simply due to the fact that some of the staff of the medical centre were more generous than others when they granted sick leave. (33) An alternative explanation might be, however, that the seriousness of smaller accidents was increasing so that longer periods of time were necessary for recovery. On the other hand , the seriousness of accidents which caused permanent diabilities seems to have been diminishing. judging the seriousness of an accident according to a table drawn up by the American Standardisation Commission, Correggiari demonstrates that the firm's expenditure in permanent disability compensation was greatly reduced. Since the compensation for permanent diability representid a much bigger expense than the loss of working days in temporary sick leave he was able to show that the overall result of the accident prevention policy was an impressive saving for the firm. (Table 2) Although no figures are quoted Table 2:Cost of Industrial Accidents per 1000 Hours Worked, 1926 to 1928. (1926= 100) 1926 100 1927 78 1928 70 Source : A.Correggiari , " La prova dei fatti " , Sprazzi e Bagliori, gennaio 19 30, 46. for 1929, since at the time of writing they had not yet been compiled , Correggiari maintains that the figures for the first ten months promised that the accident rate would prove to be as low or even lower than the 1928 level. (3 4) Without further information, it is not possible to evaluate these figures properly, but they do seem to suggest that the accident prevention policy did achieve a reduction in both the number and seriousness of accidents in the first years of its existence. Unfortunately, we have no comparable figures for the 1930s nor any indication of whether industrial diseases became less common. Whether successful or not, nevertheless, these initiatives add up to a serious health and safety campaign in comparison to many other contemporary firms and they testify to the fact that the Magneti Marelli management and the factory doctor Correggiari were prepared to experiment with American ideas that had not yet been tried in Italy. The factory archive does, however , reveal one striking exception to this generally harmonious picture. This firm was keen to present the image of a caring management doing everything possible to safeguard the workforce's health, but the question of silicosis demonstrates that they were not willing to accept any questioning of their ability to do so. The cases of silicosis also suggest that the health and safety policy may have altered with time and the early seriousness and enthusiasm may have given way to a more strong arm policy. It is, however, very difficult to be ertain about this since the absence of documents relating to the earlier period may simply mean that they have been lost.(35) In Italy, silicosis had traditionally been seen as a miners disease and it was only slowly recognised that it could also be an occupational health risk in certain engineering jobs. Since the Italian mining sector was small this was considered a rare disease (36) and the 1934 legislation which made compensation automatic for six industrial diseases omitted silicosis from the list. In spite of this, a number of Magneti Marelli workers did attempt to get compensation in the late 1930s and early 1940s. Most of these sued after the firm sacked them for reasons of ill-health. (37) Only one record survives of a worker being paid compensation and the sum was fairly small - equivalent to about eighty days pay. (38) The firm won certain cases by arguing that the problems that these workers had with their lungs were due to other causes whose origin was outside the workplace. (39) Yet medical journals in the 1930s show that that the link between sandblasting r any other Sob carried out near it, was understood fMay contemporary medical experts were aware of these dangers and, furthermore, they considered that the use of sealed in workcabins and ventilators, such as those cited by the Magneti Marelli in its defence, was insufficient protection. (40) The firm was willing to pay high fees for lawyers and professional experts which suggests that it was less concerned about the immediate expense of paying compensation to the particular worker concerned, than about the danger of setting a precedent. This may mean that the eight surviving records of cases of workers who took the firm to court may have been only a fraction of the potential number . The case of Francesco Galbiati (40) demonstrates the atmosphere in which workers tried to get compensation. Galbiati worked, in 1935, in the Heat Treatment Shop next to a vat of potassium cyanide. Fumes from this permanently damaged his lungs, as was recognised by the factory medical officer Fulghieri, who recommended that he should be transferred onto other work. But Galbiati wanted compensation since his health was ruined and he took the firm to court. He was unable to get compensation, however, until after the fall of Fascism and the Liberation when the firm was temporarily run by a managing director appointed by the National Liberation Committee Brasca. In a letter to Brasca in 1946, (41) Galbiati describes how the Personnel Manager of the firm tried to prevent the court case by promising a friendly settlement. No money ever appeared and as Galbiati continued to push for justice, the promises of a cash payment turned to threats and he had to drop the matter. By this time, it was 1942 and workers who caused trouble could be mobilised into the army. These cases of silicosis underline the essentially authoritarian nature of the firm's policy. The management took the issue of health and safety very seriously but their would not allow their competance in this matter to be questioned by the workforce . This was not difficult in a regime that had destroyed trade unions and favoured employers rather than workers , a situation that was only further exacerbated by the war. Further cracks appear in this apparently benevolent policy if we examine the management's motivation for taking such as interest in industrial health. To understand this , we need to look first at the relationship between industrial health and scientific manageme nt. Henry Ford was interested in industrial health and safety but not simply for charitable reasons . He maintained that not only was it socially desirable to protect the health of the workforce but also that it could help keep productivity high. "One point [he wrote] that is absolutely essential to high capacity as well as to humane production, is a clean, well-lighted and weIl-ventilated factory " . s In his view, the social benefits of an indu strial health and safety policy were an integral part of scientific management. In spite of this, his policy retained paternalistic and authoritarian characteristi cs since it saw workers essentially as children who were unable to look after themselves . The Magneti Marelli, strongly influenced by American ideas, saw health and safety as more than simply a question of protecting the workers' well-being. Correggiari stressed this in 1929, when he claimed that, in this firm, "accident prevention is based on the principle of u. In the eyes of both the management and the workers the link between scientific management and accidents is perfectly clear. " (his italics) s He does not, however , clarify exactly what he means by this and we need to look more closely at the nature of this link. To certain extent it is true that a dynamic health and safety policy was actually necessitated by the American-style organisation of production which created new and unprecedented hazards . Production tempos were much faster and at this accelerated pace workers could be under constant stress and therefore at risk. Umberto Quintavalle himself recognised this when he wrote, in 1928, that, "the faster work tempo imposed by modern rationally organised production only worsens the [health and safety] situation since the nervous tension and increased physical effort required undermines the worker's resistanc e unless we also introduce appropriate preventative measures " s Not only the pace but also the type of work could cause problems since, to some extent , scientific management meant the division of work into repetitive and essentially boring tasks , which dulled the workers " senses and made them less careful. There were further dangers inherent in the rapid technological innovation; constantly changing machinery and new processes meant unknown health risks . In contrast to some other firms who tried to deny the existence of risks specifically created by the new approach to management , all of these problems were taken seriously by the Magneti Marelli. Scientific management not only caused health risks but also, conversely, facilitated an innovative approach to the problem. The tools of scientific management could , themselves , be used in the fight against industrial disease and accidents . Thus , it could be claimed that the health policy was , in itself , "rationalised". New dangers were tackled with innovative weapons , which meant not only the American-inspired Safety Committee, but also the Psychotechnical Department with its "rational" recruitment policy. One reason why this aspect was strongly emphasised by the management may have been due to the fact that the rapid changes inherent in scientific management had to be imposed upon the workforce . In this situation, it was important to attempt to present technological and managerial innovations as beneficial to all. A good example of this was the workers " suspicious attitu de towards the Psychotechnical Department. Furthermore, scientific management enabled the firm to see the industrial health policy not as a cost and burden but rather as a self-financing measure. At first, this was not mentioned and an article in the factory newspaper , (45) in 1925, claimed that workers health was simply a question of the benevolence of the employers. However, this attitude was soon abandoned and various articles on the health and safety policy emphasized that it paid for itself since acciden ts which disrupted the flow of work were costly, sick leave and compensation meant lost production time and expense and healthy workers were more productive . In fact, as Correggiari noted in an article, in 1930, the management were not willing to spend any more than they calculated would be returned in this way. "It may seem [he wrote] that these provisions are too expensive and sometimes have an unfavourable effect on productivity: as far as cost is concerned, it should, of course, always be kept in proportion to the increased profit yielded, otherwise it would be uneconomic." (46) He does, however, say that, in his opinion, there was not often a conflict between the needs of production and the needs of health, so that this strict budgeting rarely obliged the firm to scrimp on protective measures. Furthermore, in the same article, he goes on to argue that greater safety protection could actually raise productivity and overall profits since "dependable accident prevention measures eventually have a psychologically favourable effect on the worker : relieved of the danger which previously threatened him he can dedicate himself more calmly to his task, feeling himself in safety he speeds up his pace of work and sometimes u there is a net increase in production " . (47) (his italics) The fact that this policy effectively cost the firm nothing throws a new light on the health and safety campaign and explains, to a great extent, why shrewd businessmen like the Quintavalles devoted such time and resources to a policy which at first sight appears to have been all to the benefit of the workforce. There were, however, further gains to be reaped from this type of policy. We can quickly dismiss as over-simplistic, the claim that the concern for health and safety was largely due to the true Fascist nature of the management. One article in the factory newspaper even maintained that the interest in preventing industrial accidents was principally motivated by the Fascist demographic campaign, since injured workers could not fight as soldiers. "Amongst the permanently injured the level of handicap varies, but the statistic s suggest that at least a third of these would no longer be capable of serving actively as fighting troops in defence of the Motherland; when added to the number of deaths this amounts to an annual loss of about 18,000 men, the size of an entire Division, which is far from negligible . . . " . (47) Although we h ave no cause to question the management's alliance to the regime , it seems highly unlikely that this approval of the Fascist demographic policy (which aimed to increase the birth-rate for nationalistic reasons) , was a serious factor in the decision to create an active health and safety campaign. This kind of claim was probably simply an attempt to make political capital out of a pre-existing policy. Another aspect of Fascist policy is, however, much more likely to have been taken into serious consideration. The Fascist Labour Charter (Carta del Lavoro) had outlawed strikes, promising that the regime would help workers and employers to cooperate productively and peacefully to build a happy and prosperous future . This was the much vaunted policy of "clags cooperation " which was supposed to replace the old destructiveness of class conflict. In many firms this tended to mean that employers were free to impose heavy wage cuts , huge increases in the pace of work and redundancies . The newly formed Fascist "sindicates " (which replaced the trade unions) could do no more than slightly cushion the effect of this onslaught on the standard of living of the working class . Strikes did occur at times and although they could not succeed they caused distruption. One example of this was the series of strikes among female textile workers in Legnano near Milan, in 1931, where battles occurred with the police. The problem of making "class cooperation " work was especially relevant to this firm since three of its plants were situated in Sesto San Giovanni, which grouped most of Milan's large industry. A working class stronghold, it was a focus for anti-Fascist activity. In 1944, for example, a secret Communist report commented that Sesto San Giovanni was, "undeniably the area [in Milan] where the mass support for the anti-Fascist struggle is strongest, not only regarding the influence of our Party and its membership level, but also in the number of actions carried out, the funds collected, the aid to the families of political prisoners, etc. This is the key zone from which all of Milan's workers take their cue before beginning any action " .s The Fascist blackshirts had destroyed the political organisations of the working class but more subtle methods were needed to win their actual cooperatio n and the Magneti Marelli management were not shy to point out that taking care of the workforce's welfare could also be a way of creating a consensus or, at least, of winning their employees' passive acquiescence. Thus, an article, in 1925, noted that the firm was willing to accept the so-called sacrifices a welfare policy entailed since, 'over and above the moral satisfaction we quite rightly feel in caring for those who have helped the firm to its current greatne ss , we are also compensated by the fact that the workforce feels a greater bond to the firm... ' s Furthermore ,willing workers were more productive, 'Th e strength of an industry like ours lies to a great extent in the goodwill of the workers; a willing worker raises productivity which benefits both production and his own interests; this creates a better and more understanding relationship between worker and firm so that they can count on each other in times of need. ' (50) It is, of course, extemely difficult to tell whether this attempt to create a spirit of consensus did actually work; whether, in fact, the workforce did feel 'goodwill' towards the firm. Neither is it possible to be certain to what extent the health and safety campaign was successful in fighting the accident rate and industrial disease, apart from the promising results of the first two y ears. It is clear, however, that a serious attempt was made to achieve both of these aims, in contrast to many of the firms descibed by Bianchi and Sapelli. The Magneti Marelli was in many ways unusual, a rare example, in interwar Italy of a firm trying to implement fordist and taylorist ideas and its health and safety campaign, as carried out by the Safety Committee and the Psychohechnical Department , an interesting and innovative policy. u 1. The Magneti Marelli was described as a "golden factory " (u) by a former Winding Shop worker employed there from 1933. Interview with Gregnanin Maria, December 1983. 2. L.Devoto,u, (A. Cordani, Milano, 1929), p. 13. 3. R. Romano, "Gli industriali e la prevenzione degli infortuni sul lavoro (1894 -1914)', in M.L.Betri and A.Gigli Marchetti(eds.), u u (Franco Angeli, Milano, 1982)p. 145. 4. u., p.143. 5. For more information on social insurance legislation see, A. Cherubini u u (Editori Riuniti, Roma, 1977) a nd G.Bronzini, 'Legislazione sociale ed istituzioni corporative' u Fu Feltrinelli,M ilano 1981) 6. A.Carbonini, 'Luigi Devoto e la clinica del lavoro di Milano' in Betri and Gigli Marchetti, u, p.515. 7. L.Devoto, "La clinica delle malattie professionali degli Istituti clinici di Milano', in u, cited in u., p.515. 8. L.Devoto, u, (A. Cord ani, Milano, 1935), p.19. 9. L.Devoto, "Una disciplina italiana e i trenta anni del suo giornale ' u u, (1931), pp. 479-480. Also cited by L. Dodi Osnaghi, 'As petti della condizione operaia e della nocivita attraverso le riviste di medicina del lavoro' in u, p.232. 10. Dodi Osnaghi, 'Aspetti', p .234. 11. G.Sapelli, u u, (Rosenberg & Sellier, Torino, 1978) passim. 12. B.Bottiglieri, 'Razionalizzazione del lavoro e salute operaia tra le due gue rre : l'atteggiamento del sindacato e del governo " in Betri and Cigli Marchetti, u, p.871. 13. Sapelli, u, p.375. 14. u., p.372. 15B. Bianchi, 'I tessili : lavoro, salute, conflitto' in u 16. G. Consonni and G.Tonon, "Milano: classe e metropoli tra due economie di gue rra', in u, p.422. 17. Various letters and memoranda concerning industrial health were found in the Archivio del Personale della Magneti Marelli (hereafter APMM), which contains the record files of all the workers employed since 1919. Information such as grade, date of birth, job etc. are recorded in these files, and some also include letters and other documents . This material. which was kindly made available to us by the Personnel Department of the Magneti Marelli, is being studied as part of a much wider research project, looking at the history of the firm in the interwar period, with special reference to women workers. 18. Sapelli, u, p. 377. 19. Various articles in the factory newspaper, u ('Sparks a nd Glows', hereafter u) describe the Safety Committee. For example, A. Corregg iari, "Esperimenti Antifortunistici', u, gennaio 1929. pp. 25-31. 20. Unsigned memorandum, c . 1935. u fasc. Sigurta Adelina. 21. "In casa nostra', u, maggio 1929, p.51. 22. u. 23. The level of education is shown on most of the APMM files. 24. Both articles in u and notes in APMM mention workers who have suggested safety modifications. 25. Sapelli,u,pp .361-2. 26. G.Sapelli, 'Formazione della forza lavoro e psicotecnica nell 'Italia fra le due guerre mondiali', u,No.1,1977,p.21. 27. M.Fossati 'La selezione del personale in una azienda industriale di grande importanza '(prima parte) ,u,giugno 1927,p.24. 28. Fossati 'La selezione'(seconda parte)u,luglio 1927,pp .21-22. 29. U.Quintavalle , "L"Indugtria e la lotta contro la tubercolosi " ,
    u,Nov.-Dic.,1928.p.8. 30. Letter with illegible signature ,24 March 1933.u. Fasc. Russo Frances co . 31.'Per difendere gli operai' ,u,giugno 1929,p.52. 32. A.Correggiari, "La prova dei fatti " ,u,gennaio 1930,p.45. 33. Ibid. 34. Ibid.,p.47. 35. The materials contained in the u are generally much richer for the 19 30s than for the preceding period. 36. Dodi Osnaghi, 'Aspetti' ,p.274n . 37. u, fasc. Imberti Aristide. 38. E.g. the cases of Magni Carmela and Moretti Ambrogio ,u. 39. Dodi Osnaghi, 'Aspetti',p.277. 40. APMM,Fasc. Galbiati Francesco. 41. Letter to P.C. Ing. Brasca , signed Galbiati Francesco, 12 dicembre 1946, u,fasc. Galbiati Francesco. 42. H.Ford,u,New edn. (Wyman and Sons,London,1924)p. 113. 43.Correggiari, 'Esperimenti Antifortunistici',p.25. 44. Quintavalle,'L'Indugtria e la lotta",p.8. 45. 'Assistenza sociale',u,luglio 1925,p.11. 46. Correggiari, 'La prova dei fatti',p.46. 47. u.,p.47. 48. Vico d'Incerti. 'La lotta contro gli infortuni',u,marzo-aprile 1938,p.3 7. 49. 'Rapporto sulla situazione organizzativa della Federazione di Milano' ,Milan o, 20 aprile 1944,in A.Scalpelli,u), (Argalia Editore,Urbino, 1972) p.95. 50. 'Assistenza sociale',p. 11. 51. u. u CASE OF THE CORNISH MINERS.>u u In this chapter I want to explore two of the questions that arise from historical examination of occupational diseases.Firstly, whether the introduction of preventive measures, or of compensation, should be seen as simply a post hoc response of sympathy or as the result of conflict between workers,employers and the state. Many examples suggest the latter is the case, albeit the various parties may play differing roles over time. I will be discussing one particular occupational disease-phthisis/silicosis amongst metalliferous miners, taking the miners of 19th and early 20th century Cornwall as examples. I suggest that the incidence of lung disease amongst this occupat- ional group was closely related to changes in the productive process and was not simply the inevitable consequence of hard rock mining. Also I stress that migration had a key relationship with disease amongst Cornish miners, so therefore also examine the unique epidemic of Ankylostomiasis that occured there during the early years of this century. Secondly, and more briefly, I explore whether the process whereby any one disease becomes recognised as compensational or indeed even as occupational has factors in common with the recognition process of other diseases? If so,can any general points be made from which perhaps a theory could be developed? Mining in Cornwall-for tin and copper plus some lead and zinc, was a long established industry and the miners were men of acknowledged skill. Technologically the industry had been revolutionised by the steam pumping engines of Watt and Trevithick which enabled far deeper mining to be undertaken. Cornwall remained one of the world's major producers of copper and tin until the second part of the 19th century, when the crisis of severe price falls forced another revolution on the industry (l). The demand for metals from the growing industrial economies of Europe and the United States had led to the development of new and greater sources of supply. The lifting of Tariffs on imported ores; the establishment of Free Trade; the opening of the Amsterdam Metal Market-all in the l84Os, signalled the expansion of world metalliferous mining on an unpreced- ented scale. Rapidly increasing suppIies of copper from Chile led to a slump in price in l866. This was followed by equally steep falls in the price of tin from 1873 as the easily mined deposits of Queensland, Australia, were exploited. For a hard rock, high cost producer such as Cornwall these price falls were catastrophic. Initially the effects of competition and price depression were countered in the traditional way-with closures of the more marginal mines and with large scale unemployment. However, as the price of tin continued to fall, new strategies were necessary if the industry were to survive. The first of these was technological innovation, then, 2. when this proved insufficient, the industry itself was completely restructured. From 1895 most of the remaining mines had been formed into Limited Liability companies and were seeking outside investment (2). The technology turned to in the 1870s was rock drilling machinery. This, together with increased use of dynamite for blasting, following the expiry of Nobel's patent, meant that not only was there more dust in the mine air but also that the dust Particles were very much finer. Since phthisis developes when dust containing free silica of less than 5 microns is regularly inhaled (3) such changes were significant. From 1875 the use of rock drills in the major mines enabled the Cornish companies to maintain output with a greatly diminished workforce. The depressions of the 1860s and 1870s caused large scale migration from Cornwall. Indeed, one third of the population left the county between 1871 and 1881. Migration was no new phenomenon however. From the late 18th century Cornish miners had been going and coming between Cornwall and other metal mining districts. Initially within England and Wales, then, as the mineral frontiers expanded, to other parts of the world. These migrations - to Central and South America from the 1820s; to the United States from the 1840s; to Australia from the 1850s - were mainly undertaken by men on their own. These single roving miners left wives and families behind in Cornwall. Their intention was to return. Sometimes they did so. Sometimes they sent for their families to join them overseas. Sometimes they moved on, from Mexico to California for example, when gold was found there in 1849. I have suggested that the single roving miner was a particularly Cornish phenomenon (4). Family migration was far more likely to be depression pushed and permanent. Yet paradoxically the time of deepest depression in Cornish mining was the time that provided the last real opportunity for the single roving miner. The development of the South African goId fields from 1888 brought demand for skilled mine labour. By 1895 more Cornishmen were working in the Witwatersrand mines than were working in the mines of Cornwall. During the last part of the 19th and the early part of the 20th century, the links between Cornwall and South Africa were very close. Not only was 25% of the white workforce at the mines from Cornwall, but also there was considerable export of mining machinery and equipment. The Cornish firms of Harveys and Holman provided boilers, pumps and drilling machines for much of the initial expansion of the Rand, although later they were to be superseded. Harveys indeed maintained a Johannesburg office some years after the Anglo-Boer War. There were Cornishmen too in senior positions in the major mines. Men like Josiah Paull the manager of Ferriera Deeps, or R. Arthur Thomas who returned from the Rand to become manager of Dolcoath, the largest mine in Cornwall. In addition there were important geological similarities between the two countries. Cornish tin and Witwatersrand gold both lay in country rock containing a high degree of quartz and where lodes and ore contained very large concentrations of silica. The migration of the Cornish 3 to the Rand and back thus set up a macabre pattern of the sub-migration of phthisis and its attendant disease of TB. This can be clearly seen in the u u Report 1904, where it was revealed that those who had worked in the gold fields of the Transvaal suffered from the highest death rate from phthisis of all miners investigated. Between 1900-1902 three hundred and forty two deaths were investigated in Redruth, Camborne,Illogan Gwennap and Phillack sub-regional districts of Cornwall (all mining areas).Of these, l85 had worked in South Africa and another foreign country (5). This grisley migration had been recognised in Cornwall during the 1890s especially once men returned on the outbreak of the Anglo-Boer War. Many came home with their lungs ruined and died in such numbers that in Cornwall miners' phthisis increasingly became known as the 'Africa disease'. The composite nature of phthisis is important not only in discussing the pathology of the disease, but also its incidence and migration between Cornwall and South Africa.It is also significant when considering what control measures were or were not imposed on mining operations in these two counties. Medical research into dust diseases of the lungs had declined during the later part of the l9th century in Britain.Experiments in the 1860s by E.H.Greehow had confirmed that impregnation of pulmonary organs with dust was the result of the inhalation of vitiated air, but improvement in coal mine ventilation together with Kochs discovery of the tuberculos bascillus focused medical attention on bacteriological causes away from non-medical prophylactic measures.In South Africa it was not until the Transvaal Mines Regulation Commission of 1907-1910 that serious efforts were made to apply Greenhows discoveries to underground conditions in the gold mines (6). It then became increasingly obvious that the mixed dusts in the mines atmosphere were what had a material effect upon the cause and development of phthisis. That such a complex composite disease was produced by variable factors suggests that its incidence clearly altered with the type of mining undertaken. There was strong evidence to show that both in Cornwall and South Africa the prevalence of the disease was inextricably linked to changes in the productive process.These in turn were related to the constraints imposed upon mining for profit under differing conditions of production. The enormous growth of the South African mines and their extensive degree of mechanisation intially masked the fact that similar innovations in Cornwall, albeit on a smaller scale, had the same deadly consequences. Miners' phthisis migrated with the miners between Cornwall and South Africa and back, but the disease could be contacted in either country. This can be clearly seen from the number of deaths recorded in Cornwall during the earlier part of the 1890s whilst the great outflow of labour to South Africa was underway. Between three and four hundred men dies of phthisis between 1893 and l898. Similarly, the scale of the 'Africa disease' can be seen in the sharp increase in 4 deaths following the outbreak of war. The 359 deaths from phthisis in 1899 rose to 490 in 1901. Although the technological changes that led to greater dissemination of finer particles of dust placed all catagories of underground workers at risk, it was the men who worked the rock drills who faced the greatest danger. To work a rock drill in Cornwall or South Africa during the 1890s was to face almost certain death. The only difference between the two places was the length of time involved. In 1902 it was calculated that a rock drill worker in Cornwall had an average of eight years such work before dying of phthisis. In South Africa it was four years. Of course, Cornwall and South Africa were not the only mining fields to be so affected. All over the world mechanisation had been introduced to metalliferous mines in varying degrees and with similar consequences by 1899. The rising incidence of phthisis deaths in the American and Australian mines led to labour agitation for better working conditions. These conflicts, coupled with expansion of the mining industries, led in time to provision of compensation, medical inspection, and the introduction of the axial feed drill-which made water an integral part of the drilling process. In South Africa these measures were also introduced following labour conflict, with however the added reaction of a greater use of black labour. These men too died in their thousands from phthisis. Only in Cornwall where the industry was rapidly declining were labour protests muted. During this period of decline, the Cornish mines strove to retain their profitability by further cutting of working costs and neglect of working conditions. In the now transformed industry profitability was bought, more than ever before, at the expense of the health of the working miners. Furthermore, the Cornish mine companies resisted all attempts to get phthisis included in the schedules of compensatory illnesses. They argued that it could not be established that men had contracted the disease in Cornwall rather than South Africa. Even after 1918 when the u made silicosis a compensatable disease for miners, little attention appeared to be paid to the Act in Cornwall. However, there is evidence that between 1912 and 1916, miners from Cornwall, knowing they had phthisis, were going to South Africa to work in an attempt to get the lump sums offered in compensation at that time. Furthermore, for many years after 1918, the Miners 'Hospital at Redruth in Cornwall was kept busy supplying X-ray evidence for compensation claims in South Africa. The part played by the Cornish Miners, and the cost to them of sustaining the differing fortunes of the Cornish and South African mines had been recognised by Government researchers in 1909. A Report to the u u stated:- 5 "Both in South Africa and Cornwall the nature of the work is conducive to phthisis in the case of the miner and to pauperism after his death of his widow and dependents. The conditions however vary in the two cases. In Cornish mines the wages are low and the conditions highly injurious. In the South African mines the conditions are very much more injurious but the rate of pay is high" (7) . The connection between Cornwall and South Africa and the migration of phthisis between the two mining areas enables comparisons to be made about the relationship between disease and the productive process, and about the extent to which ameliorative measures and compensation are introduced in particular circumstances. Unlike industrial/occupational accidents, diseases like phthisis have in the main a long time lag between exposure and sympton. This makes action by workers more difficult since at some distance in time such diseases may appear inevitable, not directly attributable to company policy, something that happens to individuals on a random risk basis. The relatively short time lag between rock drill work and death in Cornwall and South Africa at the turn of the century, the numbers of men involved and the dreadfully visible and protracted manner of their deaths left little doubt that this was more than simply an occupational hazard. Nonetheless, official response and action within the industry itself differed markedly between the two areas. Despite occasional downturns and the effect of the war, the South African mines were well able to respond to labour pressure and carry the costs of compensation and safety measures. A similar response in Australia at the mines of Ballarat and Bendigo underlined the importance of gold to the industrial world economy. The declining fortunes of Cornish tin mining however, generated a very different response. In 1899 the Inspector of Mines had explained his failure to insist upon the implementation of safety regulations by stating:- "I have not felt it expedient to press the matter as strongly as might be,for fear of arriving at the last straw which might bring about the total collapse of what little mining vitality remained"(8). The industry resisted attempts by the state to enforce compensation in 1909 and ignored legislation after 1918. Although masks were made available for rock drill workers these proved difficult to work in and were unpopular with the miners. Men who did not wear them however, were subsequently 'blamed' for developing phthisis. Similarly, initial attempts to keep down dust through watering slowed down working speed -no small matter to men on contract - and forced the miner to work in mud and wet. Many men switched off the water. Phthisis then became their 'own fault'. 6 This tactic of 'blaming the victim' can also be observed by examining the Ankylostomiasis epidemic in Cornwall. Similarly, there was differing reaction from workers and employers in areas of differing industrial fortunes and migration again played a key role. Ankylost- omiasis is the disease resulting from infection by the hookworm u. The adult worms inhabit the duodenum and upper part of the small intestine and the enormous number of eggs produced by the female are passed out of the body via the faeces. If the faeces remain in a moderate temperature for a few days these eggs hatch and develop into larvae and worms. It is by swallowing the larvae, most usually by faeces polluted soil on the hands to the mouth, that humans are reinfected (9). In tropical conditions where sanitation is poor, Ankylostomiasis is still endemic. In the hot moist, muddy conditions of most Cornish and other mines (where sanitation was non-existent), the worm, once introduced thrived. The symptoms of Ankylostomiasis are similar to those of anaemia-pallor, lassitude, dizziness, breathlessness, fatigue at smallest exertion. In addition infected persons might develop pustular eruptions on the skin. Although rarely fatal, the disease was not one that allowed sufferers to carry on hard manual work. As had initially been the case with miners' phthisis, the pallor caused by Ankylostomiasis was attributed to bad mine ventilation. 'Miners' Anaemia' was thus seen as a worsening of the general debility resulting from mine work. The actual cause of the disease was first noted by Perroncito in 1882 as a result of post mortems carried out on men who died during the digging of the St Gothard Tunnel in Switzerland. He also established that the disease was in existence amongst miners in Hungary, France, Belgium and Germany. However so strong was the belief in the 'bad air' theory that few if any measures were taken to eradicate it. From 1900 however, the introduction of compulsory watering in the coal mines of Westphalia (to prevent coal dust explosions) provided an underground environment highly suitable for the spread of Ankylostomiasis. Cases of the disease rose from 275 in 1900 to 1,355 in 1902 (10). The original infection was thought to have come with miners from Hungary, and a complete ban was put on foreign labour. The resulting labour shortage helped strengthen the demands made by the miners for the introduction of sanitary facilities and for payment whilst suspended from work due to infestation. In Cornwall, links had been made between migration and severe anaemia in the late 1850s and early 1860s before the existence of the parasite was known. A Penzance doctor had observed symptons of severe anaemia amongst miners lately returned from Chile, and a St just doctor made similar observations of other men. In 1898 the Chief Inspector of Mines drew attention to Perroncitos work in his Annual Report and alerted management and men to the true nature of the disease. Thus when men working 7 in and around the New Engine Shaft at Dolcoath mine began to display symptons of anaemia the manager, Mr R. Arthur Thomas, had little doubt as to the cause even though he took measures. The local Inspector of Mines still subscribed (as did many local doctors) to the 'bad air' theory, and it was on that ground that he applied to the Home secretary for permission to have an enquiry conducted into the health of Cornish miners. The resulting investigation by J.S. Haldane not only revealed the incontrovertible relationship between rock drills and miners' phthisis, it also provided full details of the extent of Ankylostomiasis in Cornish mines. Almost certainly the worm had been brought to Cornwall by men returning from the tropics rather than from Europe. Although a few cases of Ankylostomiasis had been noted at the Kimberley diamond mines, there were none in the very much drier mines of the Rand. A far more likely source of infection were the gold mines of Mysore, India. These had been expanded during the 1880s with the expiry of the old East India Company leasehold and the entry of British capital. One of the major mines on the Champion Lode was managed by the John Taylor Company, the world famous firm of mining engineers. This company had used Cornishmen in its undertaking since the first John Taylor had sent men to the Real del Monte mines in Mexico in 1823. There seems little evidence however of a complex relationship between Cornwall and India in the way there was with South Africa. The use of white miners was limited to shaft sinking and development work. The underground labourforce at Mysore consisted of Indian man, women and children. By 1893 the period of expansion at Mysore was over. Indeed, the gold field was in eclipse beside the richer fields of the Rand. At this time many of the white miners were paid off , although some remained in a managerial capacity. Many of the men went from Mysore to the Rand, others came back to Cornwall It was at this time that cases of severe anaemia began to be admitted to the Miners' Hospital at Redruth. Of the 116 cases admitted between 1893 and 1902, well over half were from Dolcoath mine, and most of these were men who had worked in or around the New Engine shaft and sump. In particular the skin irritation and pus filled sores that preceded an attack became associated with sitting or leaning against rock or timber in that part of the mine and were called 'New Sump Botches' (11). The Haldane enquiry revealed that nearly all the men working at Dolcoath and at many of the other Cornish mines, carried Ankylostoma. Many also carried other intestinal worms. These too were of tropical origins, and were similarly spread by ingestion of eggs or larvae. This was emphasised by the finding of the tape worm u rather than the much more common u u (l2). As T.Solium is passed on via an intermediate host and therefore most often caught by eating infected meat, the presence of that worm would have related the disease to the miners home and diet rather than their place of work and migration patterns. The epidemic in Cornwall, at a time when the similar but larger scale, epidemic in Germany was causing labour unrest and loss of production, caused alarm. Fears were expressed that the disease might spread to the British collieries. Haldane was dispatched to Westphalia to seek 8. further information on combative measures. His Report underlined what was already clear. That to prevent the spread of the disease it was necessary to have adequate underground sanitation. However, it was not the neglect of the mine companies in installing such facilities that was stressed. In almost all the many reports and articles on Ankylostomiasis in mines, the blame was put on 'the filthy habits of the men' (13). "It must be clearly understood, however, that the prevention of the disease is largely in the hands of the men themselves and that it is their clear duty to observe and if necessary enforce, the precautions necessary for preventing the pollution of a mine"(14). Fears that the disease would reach the coal mines proved groundless; only one case, in Glasgow, was reported amongst colliers. Yet the extent of infestation in the Cornish mines was considerable enough for several new cases a year to be reported for a decade after the Health of Cornish Miners Report of 1904. This brief examination of occupational disease amongst metalliferous miners, suggests at the very least that the recognition of a disease as industrially generated and the introduction of compensation depends on a number of factors - These factors include the state of medical know- ledge and the degree of effectiveness of organised labour, also perhaps the amount of time lag between exposure to u accident was an altogether more straightforward, albeit that blame was more often laid upon workers for acting 'recklessly' than upon employers for their constant failure to provide a safe working mileau in which such recklessness would be unnecessary. For example, in case of accident arising from a miner riding to the surface in the kibble (ore haulage bucket) it was more likely that the miner himself would be prosecuted for breaches of the 'safety regulations' than the mine company for not providing any means to mechanically raise the men to surface. Cornish miners continued to face a thousand feet of ladder climb after their days work, long after lifts had been installed in the collieries. Nonetheless, the result of accident was immediate and obvious, the link between changes at work and increases in deaths from disease was often more difficult to perceive. The two most important factors in the recognition of a disease as both industrially generated and compensatable however, would appear to be firstly the importance of an industry to the national economy, and secondly that industry's current condition. The differing response to phthisis compensation in Cornwall and South Africa exemplifies this. These factors provide the context in which labour agitation for compensation may or may not be successful. Similarly, fears of labour unrest in vital industries may generate action by the State - as in the case of the Ankylostomiasis epidemic in Cornwall where fears of the disease spreading 9 to the far more crucial coal industry provoked government enquiry and action. Given the Westphalian example, the government can have been in no doubt that had the disease spread there would have been considerable unrest with expense to the industry, and possibly the state, arising from loss of earning payments. Although treatment for Ankylostom- iasis was compulsory in Cornwall no financial compensation was paid there. The state of the industry together with the established pattern of migration precluded effective labour militancy. It was not until the outbreak of war in 1914 closed the migration escape route that Trades Unionism became established in the Cornish mining industry and the following years were marked by industrial conflict, but even then the decline of the industry rendered such conflict ineffective at other than purely local level. It is possible to suggest that a typology could be drawn up mapping out the career of a disease from acknowledgement of its industrial causes through to the establishment of state compensation schemes and the subsequent working of such schemes in practice. Certainly a brief overview of historical and contemporary studies of miners and quarrymen here and elsewhere suggests such a typology for mining dust diseases. To establish such a typology would not only increase our historical understanding, but would also enable wider questions of policy to be acknowledged and addressed. u 1. Burke G.M. u u University of London PhD 1982. 2. Burke G and Richardson P 'The Decline and Fall of the Cost Book System in the Cornish Mining Industry 1895-1914' . u XXIII no 1 (1981) P4. 3. Parkes W.R. u (London) 1974 pp 166-216 4. Burke G 'The Cornish Diaspora of the l9thC' in S Marks and P Richardson (Eds) u u (London) 1984 pp S.PP 1904 xiii (Cd 2091) u u 6. Burke G and Richardson P The Profits of Death: a comparative study of Miners' Phthisis in Cornwall and the Transvaal 1876-1918' u Vol 4 no 2 1978 P 149 7. PP 1909 u xvi (Cd 4653) Appendix IX. Final Report on the relation of industrial and sanitary conditions to Pauperism. by A. D. Steel Maitland and Miss Rose E Squire. 8. PP 1899 5,xv (c 9264-vi) Report of HM Inspector of Mines 9. Lucas A.O. u u (London) 1976 pp 132-137 10 PP 1903 XV (Cd 1671) u u by Mr T.R.Mulvany, HM consul General at Dusseldorf and Dr F Ph Koenig British Vice Consul. 11. Boycott A.E. and Haldane J. S. 'An Outbreak of Ankylostom- iasis in England. No 1. 'u 1903 Vol 3 P 104 12. Boycott A.E. 'Further observations on the Diagnosis of 10 Ankylostoma Infection with Special reference to Examinations of the Blood'. u Vol 4. 1904 pp 477-479 13. ibid P 479. 14. PP 1902 XVII (Cd 1318) u u by J. S. Haldane. u: u u The slate industry had become a commercial enterprise in the counties of Caernarvonshire and Merionethshire in North Wales by the mid-eighteenth century. s At the end of the nineteenth century, this area included the two largest slate quarries in the World, Penrhyn Quarry near Bethesda and the Dinorwic Quarry at Llanberis, and the largest slate mine, 0akeley at Blaenau Ffestiniog, as well as fifty smaller mines and quarries scattered on the hillsides.s The industry was at its height at this time and employed between 13 and 15,000 workers. 0verseas competition and changing fashions in roofing adversely affected the industry in the early twentieth century and it was never to recover its former prosperity. In 1910 there were still 13,000 workers in the industry, but by 1945 the number had dropped to 3,520.s A recent study of the health of the workers in the industry by J. R. Glover u., published in 1980, showed pneumoconiosis to be very prevalent.s Tuberculosis has not been a major problem in that industry or elsewhere in Britain since the early 1950s when streptomycin and related drugs were introduced. However Glover' s study showed many of the lungs of the older miners to have healed tuberculous lesions, indicating a very high prevalence of tuberculosis among workers in the industry some thirty years previouly. Modern epidemiological studies suggest that silicosis and pneumoconiosis predispose to tuberculosis. The first detailed study of the health of the North Wales slate districts was published by Dr T. W. Wade of the Welsh Board of Health in 1927. s This was followed by a survey by Drs C. H. Sutherland and S. Bryson of the Mines Department in 1930,s and by Dr Q.D. Chalke of the King Edward VII Welsh National Memorial Association in 1933.s A Ministry of Health Committee of Inquiry into the Anti-Tuberculosis Service in Wales and Monmouthshire, set up in 1937 under the chairmanship of Clement Davies, Liberal MP for Montgomeryshire and future leader of the Liberal Party, which reported in 1939, also received evidence from the area in their investigations.s The causes of tuberculosis in North Wales were being discussed constantly throughout this period in the press and at public meetings. This chapter considers why attention was directed to the health of this area, and focuses on the discussions of the local medical profession, their recommendations, and the underlying assumptions concerning health and disease which the discussions revealed. The attitudes of the workers themselves are also considered as far as they can be ascertained. It was not interest in silicosis, or the hazards of the slate industry, which drew attention to the health of the North Wales quarrying districts, but rather the high tuberculosis death rates which prevailed in the area. This concern for the high tuberculosis rates was partly related to the general interest evidenced in the state of the nation's health during the inter- war period, also reflected in studies of malnutrition and poverty. Tuberculosis was often said to be a reliable index of the health of the people, and its causes to lie in social conditions. Richard Titmuss, for example, wrote in 1939, 'This disease, of all those studied, appears to be the most sensitive to variations in such indices of poverty as unemployment allowances, poor relief and a sustained experience of depression in a given area. . . Almost always such indices are faithfully reflected in a rise of tuberculosis mortality and morbidity, especially in the responisve age groups (15 - 35) for both men and women.'s The Chief Medical Officer, Sir George Newman, also wrote in his Annual Report for 1921 that, 'The close association of poverty or lack of adequate nutrition with a tendency to higher tuberculosis rates is increasingly evident.'s However, such statements, most sensitive to variations in such indices of poverty as unemployment allowances, poor relief and a sustained experience of depression in a given area... Almost always such indices are faithfully reflected in a rise of tuberculosis mortality and morbidity, especially in the responsive age groups (15 - 35) for both men and women.'s The Chief Medical Officer, Sir George Newman, also wrote in his Annual Report for 1921 that, 'The close association of poverty or lack of adequate nutrition with a tendency to higher tuberculosis rates is increasingly evident. 's However, such statements, increasingly charged with political implications,s were to become less frequent in the medical officer's reports. An investigation into one of the 'black spots' of tuberculosis, Tyneside, was carried out in 1933.s Attention was also drawn to Wales as possessing some of the worst 'black spots' of tuberculosis, particularly the north of Wales. While the tuberculosis death rate for England and Wales from 1930-6 was 0.724 per thousand population, those for the slate quarrying districts of Caernarvonshire, Gwyrfai Rural District and Pwllheli Borough, were 2.052 and 1.718 respectively.s Moreover, the national death rates had been declining while the rates for males in Gwyrfai had risen from 1.88 in 1909-13 to 2.16 in 1921-5, and 2.43 in the period 1922-31.s In Merionethshire, the slate district of Ffestiniog had a tuberculosis death rate of 1.48 in 1922-31 and 1.938 in 1930-36.s The two counties of Caernarvonshire and Merionethshire had the highest death rates from tuberculosis of all counties in England and Wales in 1932.s Another important factor in fostering the interest in studies of tuberculosis was the very existence of organisations and offices for dealing specifically with tuberculosis, which had been growing up since the early twentieth century. In the nineteenth century those who contracted tuberculosis had been largely ignored or relegated to Poor Law institutions; tuberculosis had been regarded as an inherited, constitutional disease over which medicine had little control. A change of outlook followed the establishment of a special type of tuberculosis institution in Germany by Hermann Brehmer in 1859. Brehmer had argued that tuberculosis could be cured and claimed successful results from the 'open-air' treatment practised in his institution. It was not until the 1890s however that the movement spread to Britain. An important factor was the discovery of the tubercle bacillus, (or u), the causal agent of tuberculosis, by Robert Koch in 1882. This discovery seemingly brought tuberculosis into line with other infectious diseases and led to a more positive approach to prevention and cure. Despite Koch's claim to have discovered a cure in tuberculin (a culture of the tubercle bacillus), no actual cure had yet been found. Nevertheless, there was great enthusiasm for 'open-air' or 'sanatorium' treatment. Moreover, there was a belief among the medical profession that, now that the cause was known, the discovery of a cure was imminent, and hence an enthusiasm for research which could best be undertaken in an institution. In 1886 there had been nineteen hospitals specialising in tuberculosis in England and Wales;s by 1920 there were 388 institutions providing for tuberculosis patients as well as 398 dispensaries.s These in turn generated a body of specialists whose particular concern was the treatment of and research into tuberculosis. The National Association for the Prevention of Tuberculosis, founded in 1898, (which financed the 1933 study of Tyneside), was one manifestation of the new interest in the disease, and the King Edward VII Welsh National Memorial Association, founded in Wales in 1910, was another.s The latter was specifically founded to provide institutional treatment of tuberculosis in Wales, but became increasingly involved in other aspects of the tuberculosis problem, that is in prevention and research. It was responsible for the 1933 study of Gwyrfai. It was also reponsible for initiating the 1937-39 Inquiry into the Anti-Tuberculosis Service in Wales and Monmouthshire, as the result of a dispute with the Welsh Local Authorities over the latter's financial contributions to the services. By the 1921 Public Health (Tuberculosis) Act, institutional treatment of tuberculosis had become a statutory obligation of local authorities. A special clause had stipulated that Welsh authorities would be fulfilling their obligation by coming to a financial arrangement with the Memorial Association. The amount demanded by the Association for tuberculosis services had steadily increased until 1937 when their estimated expenditure for 1941 amounted to $380,000.00 (annual costs for 1930-33 had been $206,361.00).s The Welsh Local Authorities objected to the increase claiming they were spending a disproportionate amount of their public health finances on tuberculosis. A representative of the Flintshire County Council pointed out that the Association swallowed up fifty per cent of the County's gross expenditure on health services. 'Having regard to the fact that tuberculosis is responsible for only 7% of the total deaths in Wales, it seems to us that this expenditure is out of proportion.'s The Association argued that the increased expenditure was necessary and justified, and they demanded an inquiry into the tuberculosis services in Wales.s Thus it was tuberculosis in the general population and not specifically diseases related to the slate industry which attracted attention to the area, although some link between the industrial process and tuberculosis had been suspected as early as the late nineteenth century.s Dr Wade was sent to investigate the area in 1926 by Neville Chamberlain, then Minister of Health, in response to a question in the House of Commons by Major Lloyd Owen, Member of Parliament and Medical Officer for Caernarvonshire (Southern Division), concerning the excessive tuberculosis rates in the area.s Wade's analysis of slate dust showed up to fifty per cent quartz content.s The quartz particles in the slate dust produced silicon dioxide which, when inhaled, irritated the lung and caused excessive build-up of tissue. Wade concluded that inhalation of slate dust was causing silicosis among the workers which was in turn predisposing them to tuberculosis. He concluded furthermore that, contrary to popular belief at the time, the tuberculosis of quarrymen was not less infectious than among the general population, and that therefore the quarrymen were an important source of infection for the other residents in the districts. The industrial process was therefore, in his opinion, an important factor in the high tuberculosis death rates in the - area.s Tuberculosis was not a scheduled disease under the Workmen's Compensation Acts, but silicosis had been included under the Acts since 1918. In 1918 only ganister miners and makers of silica brick who suffered death or total disablement were included.s This was broadened in the 1920s to include other industries, but not the slate industry. Nor did Wade's report result in the inclusion of the industry in the Silicosis Scheme under the Acts. The u reported on 16 June 1927 that 'the investigation carried on in an approved scientific manner appears to show that the real cause [of the high tuberculosis rates in the area] is the inhalation and swallowing of fine slate dust...'s However, the majority of the medical profession practising in the area did not accept Wade's results.s One doctor he interviewed was definitely of the opinion that slate dust was not harmful but beneficial.s Nor did the quarry managers whom Wade interviewed agree with his results, but were emphatic that slate dust was not injurious to the workers; one cited the large number of old workmen who still carried on their work in the industry.s It was reported in the u u in August 1927 that, 'There is hardly any escape from the inhalation of dust by those who rely on industry for a livelihood... The probability is that road dust is just as injurious to the human system as slate dust for it contains minute particles and it is almost certain that slate dust is not so harmful as that teaming with malignant bacteria. It is all a question of relativity and opinions differ widely on the subject. That tuberculosis is very prevalent in North Wales may be a coincidence... Everyone wishes to give the workers the best possible conditions but if all sorts of fantastic rules and regulations, incurring considerable expense, are to be foisted upon employers, the time will come when the businesses of the latter will not be worth continuing.'s They concluded with the warning that continued impositions and interferences by the state meant the diminution of capital and more unemployment.s Nor did a subsequent investigation instigated by the Mines Department support Wade's findings. In their investigation, Drs Sutherland and Bryson examined 120 men: 56 of whom showed evidence of fibrosis, 14 of silicosis, an-d only 3 of simple tuberculosis. They concluded that, 'From this it appears that the industry is not one that renders the workmen peculiarly liable to contract pulmonary tuberculosis,' s a conclusion which, according to Wade and Dr C. Dairel, a tuberculosis physician from Cefn Mably Tuberculosis Hospital near Cardiff, went further than the evidence warranted.s The latter pointed out that of the 120 cases examined, only 61 were examined by the use of an Xray which he considered essential.s The King Edward VII Welsh National Memorial Association also became involved in the debate on the causes of the excessive tuberculosis death rates in this area. Research was an increasingly important part of the work of this Association. Attention was drawn at a Council meeting in 1931 to the high tuberculosis rates in certain areas, which persisted despite the work of the Association.s S. Lyle Cummins professor of Tuberculosis and Consultant to the Association, prepared a memorandum on the subject.s He referred to Wade's report but did not discuss slate dust as an important predisposing cause. He nevertheless pointed to the necessity of further research in the area. Dr H.D. Chalke, Assistant Tuberculosis Officer for West Monmouthshire, was appointed to carry out this research into Gwyrfai, a 'black spot' of tuberculosis. The Ffestiniog Council also invited the Association to include their district in the survey following pressure from the Medical Officer for Ffestiniog Urban District, Dr J.W. Morris, who believed that slate dust predisposed quarrymen to tuberculosis.s However, for those hoping for a definitive statement on the influence of dust, Chalke's report, published in 1933, must have been a disappointment. He referred to Wade's report, but remained uncommitted on the dust issue. He wrote, 'Medical opinion in Gwyrfai and other parts of North Wales seems to differ considerably as to the association of dust-inhalation and phthisis [pulmonary tuberculosis], the weight of opinion tending to discredit such an association.' s In the discussions on the causes of tuberculosis in the area which followed the publication of Chalke's report, dust inhalation in the slate industry was rarely mentioned. When it was remarked upon, it was to the effect that it had not been proved that slate dust was conducive to a high death rate among quarrymen.s 0ne suggestion was that the money spent on dust allaying experiments, limited though these were,s might be better employed in providing facilities to ease the strain placed upon the workmen in carrying out the heavy part of their work,s in accordance with the theory that strain was an important causal factor in tuberculosis. The 1937-9 Committee of Inquiry into the Anti- Tuberculosis Services in Wales and Monmouthshire also investigated the area and came to the conclusion, on the evidence of the Tuberculosis Officer for Ffestiniog, Dr T. Watkin Davies, and the Medical Officer, Dr J. W. Morris,s but contrary to the belief of the majority of their medical witnesses, that inhalation of slate dust caused silicosis and was an important factor in the excessive tuberculosis rates of the area. The Chairman of the Committee, Clement Davies, expressed surprise that the workers were not eligible for compensation and wrote to the Home 0ffice to urge their inclusion under the Silicosis Scheme.s Watkin Davies also presented the results of his work in the area (which included an Xray examination of 117 cases) to a meeting of the Tuberculosis Association in 1939 at which Dr E. L. Middleton of the Home Office was present.s Following the publication of Davies' evidence in 1939,s slate miners were included in the Silicosis Scheme of the Workmen's Compensation Act.s If Wade and Davies were not representative of the current medical views of the 1930s, then to what did the majority attribute the high tuberculosis death rates? Wade had also isolated economic conditions as an important factor and believed that an improvement would result from a higher living standard.s Moreover, as already pointed out, it was interest in tuberculosis as a 'social' disease which was attracting much public attention to it at this time. Dr Chalke stressed sanitary and hygienic defects and was highly critical of local government. According to the u, 19 June 1933, the conclusions of Chalke's report 'cannot fail to be highly disturbing to those concerned in the administration of public health in Wales. The evidence respecting sanitary conditions in some of the villages in the slate-quarrying districts of Caernarvon- shire is startling in its revelation of a state of affairs which would seem to be impossible in any part of the country.'s However, the social and economic origins of the disease were not generally among the factors dwelt upon in the discussions on North Wales in the 1930s. Attention was focused on the following factors: race, family heredity, the fatalistic attitude of the people, improvidence and inefficiency of housewives, particularly as regard to diet, and the general social habits of the workers and their families. In his 1930 memorandum on the high tuberculosis death rates in certain parts of North Wales, Professor Lyle Cummins cited the work of by Dr Emrys Bowen, Cecil Prosser Research Scholar in tuberculosis at the University of Wales, who explained the differences between various districts in Wales in terms of race; the dark long-headed type was apparently more easily adaptable to industrial environment that the fair-haired Anglo- Saxon.s Dr W. H. Lewis of the Montgomeryshire Insurance Committee believed that tuberculosis was more prevalent in Western Wales because the Iberian type of Welshman was to be found there.s J. E. Tomley, clerk to the Montgomeryshire Insurance Committee and member of the Council of the Association, who was largely instrumental in drawing the attention of the latter to the need for an investigation in the area, regarded the coincidence of tuberculosis and Welsh speakers as important.s Dr A. C. Watkin, Tuberculosis Officer for Salop County Council, also claimed at a meeting of the N. A. P. T. in 1933 that 'in the same counties where you find tuberculosis lingering in this acute form you also find the Welsh language surviving most strongly.'s Discussing Chalke's 1933 report, an article in the u pointed out that it had already been agreed as a matter of fact that the absence of a definite and satisfactory explanation of the extreme prevalence of the disease in Gwyrfai more than in any other area was a disappointing feature in an otherwise admirable report. The article quoted 'one professionally interested student of the subject, a man who had lived and worked with the people all his life, and whose opinion was sought for the purpose of the report'. This student apparently stated emphatically that no amount of new housing, sanitation, or education would remove the scourge. The root cause, he believed, was sociological, and it was not so much new houses, new food and new ideas that the people required as new blood. Inter-marriage and inbreeding had been practised down the generations to such a degree of complexity that, in his opinion, 'the family trees in the affected villages have not only run riot but have run to seed'.s Chalke had started to plot family infection, as Dr R. C. Hutchinson had done in a survey in Carmarthenshire,s but had given up the attempt when it seemed that the six or seven hundred people in one village all belonged to one of three families.s Giving evidence to the 1937-39 Committee of Inquiry, one doctor from Gwyrfai Rural District said, 'Contrary to all that I was taught I have never seen a case of tuberculosis without some 7 family history... To me it seems that these people are born without the vital resistance to combat tuberculosis', and he advocated the notification of the family as a whole and that their children should receive special treatment from birth, although the nature of this special treatment remained unspecified.s Another doctor from the area also referred to inter-marriage among members of tubercular familes as leading to increased tuberculosis in this area.s u u, 1936, recommended a voluntary examination of each prospective partner before entering matrimony.s Marriages of near relations, they said, were to be deprecated, especially when the same weakness was present on both sides. Legislation prohibiting the marriage of tuberculous persons was not introduced into this country as it was in Germany in 1936, although it seems that at least some would have been in favour of it. Thus, despite the discovery of the tubercle bacillus, and the infectious nature of the disease, by Robert Koch in 1882, belief in the heredity of tuberculosis persisted. Another factor under discussion was the supposed natural fatalism of the people, their refusal to face facts, and refusal to undergo institutional treatment. Chalke referred to the natural fatalism of the Celtic people; he wrote, 'This failure to face facts, combined with a rather fatalistic outlook, makes the control of tuberculosis very difficult'.s Dr V. Emrys Jones, Tuberculosis Officer for Anglesey and Caernarvonshire, also said of the inhabitants of North West Wales in 1938 that they were mainly a cultivated, well-read and intelligent people, even in many instances in poorer classes. He said they were imaginative, sentimental and highly fatalistic, and regarded tuberculosis more as a disgrace than a disease. He believed that this made treatment difficult.s Tomley mentioned the refusal of the people to open their doors to the tuberculosis officer because of the stigma attached to the disease.s According to the u u, 'Even mentioning the name of the tuberculosis physician was sufficient to frighten some persons into saying "no" [to examination].' s Thus it was said they did not come under institutional treatment until it was too late. There was, however, no mention of the long waiting lists for institutional treatment which existed at this time,s nor of the financial and social consequences of the discovery of tuberculosis for the person concerned and his or her family, a very practical reason for not seeking advice and treatment at a time when the only financial assistance in such cases was charity or the Poor Law. Nor was there any questioning of the efficacy of institutional treatment in curing those who did undertake it.s Moreover, this fatalistic response to tuberculosis was not unique to the inhabitants of Wales; tuberculosis officers in England were reporting the same difficulties.s An association between tuberculosis and nutrition had frequently been noted, especially following World War I when tuberculosis rates were shown to have increased dramatically in areas with restricted food consumption.s Medical opinion in North Wales also isolated diet as an important factor in tuberculosis causation. The doctors whom Wade interviewed in 1927 considered this to be the most important factor. They believed the inefficiency and thriftlessness of the quarrymen's wives were largely responsible. Dr Griffiths of Bethesda maintained that the quarrymen's wives were thriftless and did not prepare meals properly for their menfolk who had to subsist too much on tea, bread, butter and tinned foods.s Dr John Roberts of Llanberis believed that the quarryman's mode of living and poor feeding on tea, bread, butter and over-eating on Sundays reduced his powers of resistance.s Chalke also studied the diet of the people and came to the conclusion that 'The diet of the quarryman is unjudicious rather than insufficient.'s The educational system was generally blamed for the deficiencies in the quarrymen's domestic economy. At an annual meeting of the Welsh National Memorial Association, Reverend H. R. Protheroe of Bridgend stated that the educational authorities were packing the minds of their young women at the expense of their bodies and impairing their constitutions for the rest of their lives. s The Principal Medical Officer of the Association, Dr D.A. Powell, agreed with this to an extent. He maintained that eighty per cent of those young women would end up as wives and that the next generation would be a sounder one if they were taken away from the academic side and turned to domestic work. It was pointed out at this meeting that women married young with little idea of how to care for their families. All they apparently knew was the use of a tinopener and a cork screw.s Dr Llewelyn Williams, Senior Medical 0fficer of the Welsh Board of Health, believed that it was about time they turned back to the diet of their forefathers instead of the present tinned food.s Dr John Jones of Dohgelly agreed; the people in these days did not eat proper food.s Thus there was a nostalgia for the mythical 'good old days', when the yeoman farmer tilled his own land and produced his own food. The 1937-39 Committee of Inquiry received evidence along the same lines. Dr Norris of Neath believed a certain amount of undernourishment existed in Wales, mainly due to ignorance and bad housekeeping. s Dr Hawkins and Dr Rowland Williams of Pembroke believed malnutrition in the majority of cases was due to ignorance.s Dr Roberts of Flint maintained that incorrect feeding rather than poverty was often responsible for malnutrition and that too much use was made of the tin-opener and synthetic foods.s The Committee concluded, 'The tendency of housewives to neglect, through ignorance of dietetic values or in order to save trouble, the old traditional forms of feeding and to rely largely on prepared foods is considered to have some bearing [on the high tuberculosis rates].'s Chalke, however, believed that 'bad tradition' had existed for centuries.s. A 1893 committee of inquiry had shown that the workers lived at that time mainly on bread, butter and tea.s Other social habits of the workers and their families were also commented on. Chalke did not discover alcoholism to be prevalent in the area and therefore a contributory factor in the high rates. He considered the religious principles of the people to be an important factor, for it resulted in their congregation in ill-ventilated, overcrowded churches. Another factor, he believed, was the lack of opportunity for suitable recreation in the open air. Garden shelters, introduced by tuberculosis dispensaries for domiciliary treatment, were said to be conspicuously absent in Gwyrfai, and the value of open windows was apparently not fully appreciated. The danger of kissing, he said, was too often disregarded, and the young quarrymen took a great pride in their personal appearance, particularly on Sundays, leading to a tendency to stint themselves to spend more on clothing.s A medical witness before the 1937-9 Committee also stressed the great importance attached to 'turning out smartly'; instead of dressing seviceably to suit weather conditions it was too often done with the object of 'equalling or bettering the dress of their friends'.s This witness deprecated what he said was common knowledge among those who were acquainted with the slate quarry districts, that is the tendency for the family to congregate in the back kitchen while a more commodious room was only used as 'showroom' on auspicious occasions. He also referred to the 'too common practice' of excluding sunshine with blinds and heavy curtains, and the reducing of airspace by overcrowding rooms with furniture. The heavy local rainfall was also considered a factor for many of the quarrymen often worked in wet clothes with resultant high incidence of colds.s Thus the medical commentators placed the emphasis neither on the slate dust nor economic and social conditions, but on the personal habits of the workers and their families. The people themselves were seen to be responsible for the state of their health. Some considered tuberculosis to be hereditary and regarded inter-marriage as important, others blamed the social customs of the people, their fatalistic attitude towards the disease, an improper rather than inadequate diet, as well as insufficient sleep, fresh air, and outdoor recreation. This perception of the problem was not however unique to the Welsh. John Robertson, Medical Officer of Health for Birmingham and Professor of Tuberculosis at the University of Birmingham, for example, explained the differences in tuberculosis death rates between poorer and better-class districts of Birmingham in terms of the 'ignorance and carelessness of the inhabitants', and believed it to be wonderful that more young people did not contract tuberculosis, 'for so large a number are living unhealthy lives in one direction or another.'s Self- responsibility was also the dominant theme of the health propaganda of the N. A. P. T. The conclusion of the N. A. P. T. film, ' The Invisible Enemy' : 'Go and teach the truth. The fate of each man is in his own hands,' sums up the ideological position of the N.A P. T.s How did their perception of the problem affect the responses of the medical profession? Not seeing the problem in political terms, they did not seek political remedies; on the contrary, their medical views supported the establishment. Among their recommendations, measures such as improved conditions in the mines and quarries, higher wages, and compensation did not figure prominently. Little was done to allay dust hazards in the 1930s. E. Andrewes, the Managing Director of Maen Offeren Slate Quarry Company, told the Committee of Inquiry in 1937, 'Respirators are now, I believe, provided in all the Ffestiniog Slate Quarries, but in any case there is nothing to prevent the men providing themselves with such appliances. A quite efficient respirator can be purchased for the sum of 3/6d. I am told however that many of the experienced men prefer tying a handkerchief over the mouth and nose.'s 10 The local Medical 0fficer, Morris, explained however that, in the disease of silicosis, one of the persistent features was the difficulty of breathing. When the quarrymen put on the mask the diffiQulty was increased, so they would not wear them.s Dr Lloyd 0wen, MP for Caernarvonshire, expressed regret in 1937 that the quarries in the Gwyrfai district had not made much progress in the matter of allaying dust.s Education was the solution most commonly recommended by the medical commentators, education of housewives in particular. Workers and their families were to be taught to make the best of existing circumstances. Dr D.A. Powell, Medical Superintendent of the North Wales Sanatorium had already introduced a widely commended scheme for training female patients in housework while resident at the sanatorium. They were placed in cottages 'such as would make a sanitary inspector weep', cottages 'equipped with every drawback, crammed with furniture and replete with all the gadgets beloved of the sanitary defective'. The patients were to be taught how to make such cottages habitable.s Following Chalke's report the Welsh National Memorial Association drew up an exemplary budget for housewives, and appointed two health visitors in the area to visit the homes and advise on domestic economy.s Workers themselves were conspicuous throughout the 1930s for their silence on the question of the causes of tuberculosis and the influence of slate dust. Samuel Hoare, the Home Secretary, wrote in reply to a letter from Clement Davies in 1939 that he believed that the slate workers could possibly apply for compensation under special clauses of the 1931 Silicosis Scheme.s However not a single claim had been made. The procedure for claiming compensation was expensive and conditions of eligibility far from clear. The general understanding of the situation revealed in the 1937-9 Inquiry was that the workers were not eligible for compensation because they did not come under the 1930 Silicosis (Workmen's Compensation) Act.s Nor was there any attempt by the workers or their union in the 1930s to alter the situation. Their silence may have been related to the fatalism noted by investigators. Possibly a more important reason for their silence was the fear of the economic and social consequences of contracting tuberculosis or being discovered to be tuberculous. A fullscale investigation would lead to instant dismissal of the tuberculosis cases discovered to prevent further spread of the disease among employees. Fear of loss of employment should not be underestimated given the ecomomic climate of the 1930s and the welfare provision available, or lack thereof. Moreover, the employers did not hesitate to point out that large compensation bills might result in the closure of quarries through bankruptcy. The slate industry was not a thriving enterprise at any time in the twentieth century, and was in a state of constant decline. As already pointed out, 13,000 workers were employed in 1910; by 1945, 3,520. s Even the Secretary of the North Wales Quarrymen's Union, R. T. Jones, told Wade in 1927 that he was not anxious that any additional burden should be placed upon the industry in the way of compensation to affected workmen.s Action on compensation was to come initially from outside rather than from the workers themselves, specifically from the 1937-9 Committee of Inquiry and an officer of the Welsh National Memorial Association. 11 Thus attention was drawn to the North Wales slate quarrying districts as a ' black spot' of tuberculosis. The interest was partly related to a broader concern for tuberculosis as a 'social' disease, which must be seen in the context of the social surveys of the inter-war period, and partly to the existence of a body of specialists in tuberculosis which had been growing up since the early twentieth century. The local medical profession did not subscribe to a doctrine of the social and economic origins of the disease, nor did they consider industrial processes to be important. Their views were clearly located in the dominant ideology of self-help; their aim was reformation of the personal habits of the people. While their opinions reflected dominant ideology, they had greater weight than those of politicians and journalists, for they were presented as part of a scientifically-based medical discourse. As Wright and Treacher point out, medicine had a privileged epistemological status that was usually accorded to science: if science was the accurate reading of Nature, undistorted by social interest or cultural bias, then medicine could claim to be the benevolent application of what was found in the natural world.s Whether they succeeded in changing the habits of the workers in the industry and their families is unknown; what is clear however is that the latter did not dispute the views promulgated by the medical profession. The response of the workers to the debate on the high tuberculosis rates in the industry and the area seems to have been dominated above all by fear - that fear of the economic and social consequences of being found to be tuberculous, described by Dr Chalke as a 'failure to face facts' s. 12 u 1. For the most recent histories of the industry and the area see Jean Lindsay, u u u u u u u < uIndustry>u, (David and Charles Inc, USA, 1974), R. Merfyn Jones, 'Y Chwarelwyr: the Slate Quarrymen of North Wales', in Raphael Samuel (ed.), u u (Routledge and Kegan Paul Ltd, London, 1977); and R. Nerfyn Jones, u u, (University of Wales Press, 1981). 2. R. Merfyn Jones, u, p.72; 'Y Chwarelwyr', p.101. 3. Jean Lindsay, u, p.298. 4. J. R. Glover u., 'Effects of exposure to slate dust in North Wales', u, vol.37, (1980), pp. 152-160. 'Pneumoconiosis' is used in his study as a more accurate description than 'silicosis', although the distinction had not yet been made in the period this chapter is concerned with. 5. Ibid. Also see Alice Stewart, 'Tuberculosis in Industry', F.R.G. Heaf (ed.), u, (Cassell & Co. Ltd, London, 1957), pp.645-84. Walter Pagel u, u u u, 4th ed. (0xford University Press, 1964), p.66. 6. u u u u, T. W. Wade, (Welsh Board of Health, London, HMSO, 1927) . 7. u u u, Drs C. H. Sutherland and S. Bryson, (Mines Department, London, HMS0, 1930). 8. u u u, Dr H. D. Chalke, (King Edward VII Welsh National Memorial Association, Cardiff, 1933). 9. u u u, (London, HMSO, 1939) . 10. Richard Titmuss, u u, (MacMillan & Co. Ltd, London, 1938), pp.169, 170. 11. Sir George Newman, u u u, (London, HMSO, 1922), p.62. 12. see Malcolm Colledge, 13. F.C.S. Bradbury, u, (National Association for the Prevention of Tuberculosis (N.A.P.T), 1933). 14. u, P.258. 15. u, p. 6; u, p.20. 16. u, p.259; u, p.68. 17. u, pp. 258-9; Public Records Office, Ministry of Health files, MH96/1111, 'Mortality from Tuberculosis 1932 and 1933 in Administrative Counties of England and Wales.' 18. R.Y. Keers, u u, (Bailliere Tindall book published by Cassel Ltd, 1978), p.73. 19. u, (London, HMSO, 1920), p.53. 20. For a history of the Association, see Glynne R. Jones, 'The Ring Edward VII Welsh National Memorial Association 1912-1948', in John Cule (ed.), u, (British Society for the History of Medicine, Wales, 1975), pp.30-41. 21. PR0 MH75/26. 22. u, 30 Jan. 1937. 23. PRO MH75/26. 24. R. Merfyn Jones, u, pp.34-41. 25. u, vol.194, 1377, 51, (22 April 1926). 26. Subsequent research estimated respirable slate dust to contain 13-32% respirable quartz, still large enough to irritate the lung. J. R. Glover u., ' Slate Dust in North Wales', p. 152. 27. Wade Report, p.29. 28. Alice Stewart, 'Tuberculosis in Industry', p.682. 29. u, 16 June 1927. 30. PRO MH96/1122. Wade Report, unrevised, 1926, Appendix 3 (not printed in final report). 31. Ibid., interview 19 July 1926, Dr Bradley Hughes of the Penrhyn Quarry Hospital, Bethesda. Also see Caernarvonshire Joint Sanitary Authority Meeting, u, 5 July 1927. 32. Wade Report, unrevised, Appendix 3. 33. u, Aug. 1927. Also reported in u u, 26 Aug. 1927. Road dust would, however, have included slate dust in the area. 34. u, Aug. 1927. 35. PRO MH96/1122, Welsh Board of Health, Memo 32A, Health Advisory Committee, 'Report on the Inquiry into the Occurrence of Respiratory Disease among Slate Workers in the Gwyrfai district. ' 36. PRO MH96/1122, Letter from Wade to E. L. Collis, Mansel Talbot Professor of Preventive Medicine, University of Wales, 3 June 1929. 37. PRO MH96/1 122, Jetter to Wade from W. Dairel, Cefn Mably Tuberculosis Hospital near Cardiff, 18 June 1929. 38. J. E. Tomley, u, 10 Dec. 1931. 39. PRO MH96/1056, Report of the Medical Committee of Memorial Association, 10 Dec. 1931, Memo. by Director of Research on the Incidence of Tuberculosis in Wales. 40. PRO MH55/1222, Dr J. W. Morris, evidence before 1937-39 Inquiry. 41. u, pp.74, 80. 42. PRO MH55/ 1236, Statement by Gwyrfai Rural District Council, 16 March 1938, for 1937-39 Inquiry. Also Dr V. Emrys Jones, Tuberculosis Officer, Caernarvonshire, u u, (1938), P.71. 43. PRO MH55/1211, Dr Lloyd Owen, evidence before 1937-39 Inquiry. 44. J. Roberts, Llanberis, u, 5 Aug. 1933. 45. PRO MH55/1222, Evidence of Dr J. W. Morris before Inquiry, (also reported in u, 3 Dec. 1937); PRO MH55/1250, Evidence of Caernarvonshire County Council, March 10 1938, pp.194-207. 46. PRO MH55/1222, Letter by Clement Davies to Home Office, 2 Sept. 1938. 47. Report of meeting of Tuberculosis Association, u u, vol. 33, (1939), pp.219, 220. 48. T.W. Davies, 'Silicosis in Slate Quarry Miners', u, vol.20 (1939), 543-5. 49. u u, Chairman Sir F. Rees, (London, HMSO, 1947), p. 15. (Shed workers in open quarries were included in the Silicosis Scheme Feb. 1946, p.15). 50. u, p.29. 51. u, 19 June 1933. 52. PRO MH96/1056, u u, 10 Dec. 1931, (Memo. by Director of Research on the incidence of Tuberculosis in Wales, pp. 317, 318). Emrys G. Bowen, u u, vol. 63 (1928), pp.363-399. 53. Montgomeryshire Insurance Committee meeting, u, 24 0ct. 1931. 54. PR0 MH75/15; MH96/1056. J.E. Tomley, u, 15 July 1933. 55. Dr A. C. Watkin, u (1933), p. 145. Kenneth Morgan points out that language differences in Wales implied much deeper cultural divisions, u, u, (0UP, 1982), p.88. 56. u, 5 Aug. 1933. 57. R. C. Hutchinson, 'Tuberculosis in a Welsh Country Community', u, vol. 2 (May 1921), pp.345-9. 58. u, p. 56. 59. PR0 MH55/1208, Memo. of Evidence of Caernarvon Insurance Committee for 1937-39 Inquiry, p.11. (Notification of tuberculosis cases had been made compulsory in 1912.) 60. Ibid. 61. PRO MH55/1211. u u (1937), G. Lewis Travis and E. Lloyd, Recommendations, no. 13. 62. u, p.32. 63. u (1938), p.70. 64. PRO MH75/15. u, 19 June 1933. 65. u, 19 March 1937. 66. PRO MH75/26. J. Rowland Memo. for Welsh Board of Health, 8 March 1937 (waiting list in Wales on 1 July 1935 was 281 although it was pointed out (MH75/6) that patients were not often recommended for treatment owing to the shortage of accommodation). 67. For example, J.B. McDougall and N.D. Bardswell pointed out that of the 3,000 patients treated in sanatoria for tuberculosis under the London County Council scheme in 1927, 2,280 or 76% were dead by 1932. u, vol.17 (March 1935), p.267. 68. See for example, u, vol. 11 (Sept. 1930), p.540; vol. 16, (Oct. 1934), p.31; vol. 18 (Aug. 1937) p.522; vol.19 (Jan. 1938), p.166. 69. M. Greenwood, 'The Epidemiology of Tuberculosis', u u u, (London, HMSO, 1920), Appendix 5, p. 337 70. Wade Report, unrevised, Appendix 3. 71. Ibid. 72. u, p. 18. 73. u, 19 July 1933. 74. Ibid. 75. u, 13 Nov. 1934. 76. Ibid. 77. PRO MH55/1243. 78. Ibid. 79. Ibid. 80. u, p. 36. 81. u, p. 44. 82. R. Merfyn Jones' u, p. 31. 83. u, pp. 17, 18, 43. u, 19 June 1933. 84. PR0 MH55/1208, Evidence before 1937-39 Inquiry. 85. Ibid. See also V. Emrys Jones, u, (1938), p.71; and Dr Lloyd Owen, u, 4 Dec. 1931. 86. u, (1927), pp.16, 36. 87. Synopsis of films, u (1925), Appendix 2, p.29. 88. PR0 MH55/1222, Letter from E. Andrewes, 28 March 1938, to Clement Davies. 89. PRO MH55/1222, J.W. Morris, evidence before 1937-39 Inquiry, p. 5. 90. PR0 MH55/1211. 91. u, 2 May 1924; u, p. 93; F.R.G. Heaf, u, p.711. 92. PR0 MH55/1222, Conference of Memorial Association, Caernarvon, 11 Nov. 1933, with Local Authorities and Insurance Committees. 93. PRO MH55/1222. Letter from Hoare to Clement Davies, 14 Nov. 1938. 94. PRO MH55/1222. Evidence of Morris. 95. u, p.15; Jean Lindsay, u, p. 298. 96. Wade Report, unrevised, Appendix 3. 97. P. Wright and A. Treacher (ed.), u u, (Edinburgh University Press, 1982), Introduction by Wright and Treacher, p.4. 98. u, p.32. 'CORONARY' HEART DISEASE - A DISEASE OF AFFLUENCE OR A DISEASE OF INDUSTRY? ... existing conditions of work ... impose strains which, when endured too long, are beyond physiological tolerance ... conditions thus call for amendment .. . In the field of personal hygiene, the organisation of holidays, leisure, exercise and pleasurable relaxation is as sensible as attention to sanitary habits and balanced dietaries ... Healthy living should be promoted through a more precise physiological and psychological understanding of man and of his individual and social needs. (1) Surely a prudent diet, with reduction of fat energy and control of obesity and sloth are sound policies for improving the public health. (2) These two extracts, written over thirty years apart, both refer to preventive strategies directed at the same disease, 'coronary' heart disease. They represent the prescriptive implications of two different theories about what sort of disease this is and how it is caused. These theories, in turn, rested upon two distinct pictures of the kind of person who 'gets' the disease. The idea that different kinds of people contracted heart disease led to a reformulation of medical ideas about its nature, not just its aetiology, but the very pathology involved. A re-reading of the routinely collected mortality statistics and the literature on the problems of death certification throws considerable doubt on the idea of ONE, clearly distinguishable 'modern epidemic of heart disease' . On the oontrary, chronic disease of some cardio- respiratory nature appears to have: a) been the leading cause of death in middle age for men and women since 1847, b) been expressed in vital statistics which were sorted and re-sorted over the period 1847-1970 by changes in the very aetiological theories that the statistics themselves were used to 'prove', c) accounted for more of the overall fall in the 'official' general mortality rate for middle aged men than is usually acknowledged in modern community medicine literature -- at some stages heart disease declined as fast as the infectious diseases. These points can be illustrated by reference to official reports of the Ministry of Health and the Registrar General. 1 In his Report for the year 1921, the Chief Medical Officer to the Ministry of Health was unhappy about the health of middle aged persons: Seventy years ago, wrote Sir George Newman, men of 45 had on average 22,76 more years to live. There has no improvement on this figure for thirty years. On the contrary, it seemed to decreage. (3) A Swede, according to the league tables of national health achievements presented in this and other reports of the Chief Medical Officer (CMO), could expect to live three years beyond his forty-fifth birthday more than a Britisher. Newman suggests: We must scrutinise very closely the causes of mortaliliy in later maturity . . .In England and Wales in the decennium 1901 - 1910 the largest single cause was pulmonary tuberculosis . . . (next) non- tubercular respiratory diseases. (4) Also, while he rejected the view of Sir john Simon that poverty and industrial hazards could have anything to do with this, he noted that mortality in this age group was unevenly spread across the country. Death rates were higher in industrial areas of the North West such as Lancashire. Nor can the climate be to blame, because: The very high mortality from respiratory disease of the northern manufacturing towns is a serious feature of or vital statistics, and not wholly due to climate, as a comparison of Lancashire and Cumberland proves. (5) In the Report for the year 1925, the Registrar General points out that: 'Bronchitis is particularly fatal to the urban population in the North of England,' and that the cold, which is presumed to affect respiratory disease, does not even compensate the unfortunate northerners by protecting them from an equally high mortality from heat-associated epidemics such as infantile diarrhoea. Laconically, Newman admits that 'Simultaneous excesses of 74 per cent for mortality supposed to be promoted by cold and over 100 per cent for mortality known to be promoted by heat cannot both be explained on the score of climate. ' (6) In the Report of the Registrar General for England and Wales for the year 1925 we find no commentary on heart disease at all. It seems to pass as an unremarked fact that, according to the tables at the end of the Report, something called ' organic heart disease' has been the highest proportional cause of death in the adult population for some time. In these tables, ' organic heart disease' is listed as causing 102 per thousand deaths, more than any other single category. In the Registrar General's Report for 1926, a new disease entity begins to emerge. In 1921, a new subheading of the International Classifications of Diseases (ICD) had been created: number 91 (b), 'arteriosclerosis cerebral vascular lesion'. It now became officially possible for someone to die of 'arteriosclerosis' or hardening of the arteries, whereas before, this cause had always been listed as 'stroke' (cerebrovascular lesion) without further elaboration. The Registrar himself comments that the younger, more recently trained and up to date doctors would tend to prefer the 'arteriosclerosis' term to the old fashioned 'stroke' when filling in a death certificate. The return of the younger doctors from the field of battle after 1918 was held to be the cause of a sudden apparent rise in the number of deaths from 'arteriosclerosis'. However, there was clearly a debate on the 'rise' in the number of deaths apparently associated with degenerative changes (such as 'hardening') to the blood vessels, and the Registrar is obliged to address it, despite his own caveats on diagnostic fashions: Overeating is recognised as playing an important role in the causation both of arteriosclerosis in general and of cerebral haemorrhage .. . the question whether, and to what extent, mortality from cerebral haemorrhage is increasing is of importance, because this form of mortality is well fitted to serve as an index of that from degenerative circulatory diseases in general. From time to time, cries of alarm are raised at the increase of recorded mortality from degenerative diseases of the cirulatory system. However, 'arteriosclerosis' is rapidly replacing 'old age' in certification . . . And similarly, 'myocardial degeneration' is much oftener mentioned now than in former years on the death certificate of sufferers from chronic bronchitis, etc. As one of the current rules of classification prefers heart to respiratory disease if the two appear on the same death certificate, this change in vogue of certification results in the transfer of all deaths from bronchitis etc to heart disease. (7) This Report, for the year 1926, is the first one which devotes a special section of its commentary to heart disease, though the Registrar General acknowledges it to be 'as usual, larger than any other item on the list of causes.' Further research will be necessary in order to discover with whom the Registrar General has engaging in this debate over an epidemic of heart disease between 1911 and 1925. But he is insistant that it has two main causes: firstly, the ageing of the population, and secondly, the growing unrespectability of leaving 'old age' as a diagnosis on a death certificate (and perhaps also 'bronchitis'). 'Therefore he concludes, 'alarmist pronouncements as to increase of mortality from heart disease by the "stress and worry of modern life" may be met with the observation that it is declining. ' He proves this point by replacing crude with age-standardised death rates from heart disease, which results in a picture more congruent with his general argument. However, as the economic recession of the nineteen twenties deepened, a deterioration in the health of middle aged persons became less easy to ignore. In his Report for 1927, the Registrar General admits that the death rate from heart disease has risen in some real sense, though he attributes this to an epidemic of influenza. He re-emphasises the effect of the 1921 coding rule changes which require that cardiac causes be regarded as more fundamental than respiratory causes when the two are present. It seems that the school of thought which held the rise in 'heart disease' to be a result of stressful social conditions is still powerful enough to require an answer in the official reports. By 1927, however, rises are visible in the official statistics for all major causes: rheumatic as well as 'degenerative' heart disease, bronchitis, pneumonia, tuberculosis, ulcers. The Registrar General's Report for the year 1930 does not admit defeat. It states: 'the recent increase of crude mortality from heart diseases is due, amongst other causes, to the increasing age of the population, and to rapid increase in the record of myocardial degeneration in certification of the death of old people ... When allowance is made for the disturbing influences mentioned ... the increase ... is reduced ... (8) One of the disturbing influences was another change in the rules for coding death certificates, made in 1929,. From then on, death certificates stating 'myocardial degeneration with arteriosclerosis' were to be coded to heart disease, rather than to diseases of the blood vessels generally, as had been the practice. The heart thus became a focus for a disease process which had been observed and speculated upon for some time, but formerly diffused throughout the body. With this coding change, coupled with the 1921 stipulation about bronchitis, two very common diseases now became located in the heart, both the former 'bronchitis' and the former 'arteriosclerosis' . The major step that remained to be taken before the modern pathological picture of coronary heart disease was accomplished, was to see the changes or degeneration of the heart muscle itself as 'due to' atherosclerotic occlusion of the coronary arteries. But in the 1930s, the majority of 'heart disease' was still classified as 'degenerative' rather than 'anginal' (i.e. due to coronary artery blockage) . Notwithstanding this, by the 1930s the conceptual framework had been established for the delineation of a major cause of death associated with degeneration and failure of the heart 'due to' sclerotic and fatty changes in the arteries supplying blood to the heart muscle. In this way, the muscular failure of the heart, which is the end point of many diseases, can be attributed mainly or solely to the state of the constituents of the blood or blood vessel walls. It follows from this that theories about diet, physical activity and other aspects of lifestyle can be used to account for excessive cholesterol, insufficient thrombolytic factor, unbalanced HDL to LDL ratio, absence of compensating collateral vascularisation and so forth, according to which version of the theory you espouse. The heart will then be expected to bear the 'stress of modern life' as long as the personal health practices of individuals have kept their coronary arteries in a healthy enough state. Thus the picture is almost complete, of a 'modern' disease, which, beginning at the time of the economic depression of the 1920s and 1930s, is about to become the commonest cause of death in men of working age, a picture of a disease which allows it to be attributed to rising standards of living. This can be seen from the Reports of the Chief Medical Officer for the year 1932 and 1933: 'The great constitutional diseases,' wrote Newman in his Report for 1932, "which bear in particular a social and domestic significance, have declined proportionately within the last ten years. In 1923, tuberculosis was the cause of 92 in every 1000 deaths, in 1932 it caused 69 in every 1000 deaths . . . deaths from diseases of the nervous system fell from 107 death per 1000 in 1923 to 84 in 1932; and bronchitis and pneumonia, which caused 149 per 1000 in 1923 declined to 113 per 1000 in 1932. There has, of course, 'he concedes,' been an increase in the incidence or mortality of certain other diseases. But the morbid conditions and their mortality rates referred to in the Tables ... indicate that there is no evidence from mortality in support of exceptional physical deterioration in recent years owing to social circumstances, ' (9) It should be noted here that the use of the word 'proportionately' and of proportional mortality rates (deaths from disease 'x' per 1000 death from all causes) rather than death rates per 1000 population is strategic. It avoids revealing the fact that per head of the population, deaths have risen. The CMO is forced into a position where he must argue for continued improvement in the health of the nation, not from the mortality experience of the nation, but by juggling around different causes of death which carry different (politically relevant) assumptions about aetiology. The 'certain diseases' which have increased are heart disease and cancer. In his Report for 1933, Newman, (still the CMO) is still insisting that: 'the death rates which are most sensitive and susceptible of social or physical degeneration of a people remain steady and low.' (10) With the privilege of hindsight we can see, from Logan's tables (11) published in 1950, of mortality form 1848 to 1948, that the all-causes death rate for middle aged persons was rising in 1932-33, for the first time since 1900. But Newman blithely insists: 'It is said, with truth, that the number of deaths attributed to cancer is increasing, that a large proportion of deaths is due to heart disease, . . . they are important but they do not provide evidence of national deterioration,' (12) This sounds uncannily similar to the tone adopted in reports on child health documented by Charles Webster in 'Healthy or Hungry Thirties? ' (13). The ominous death rate cannot be absolutely denied, but instead it can be attributed to a disease of 'no social or domestic significance.' It is the argument of this paper that it was the establishment of 'heart disease' as a disease 'of no social significance', rather than any particular biological phenomenon, which accounts for its establishment as the modern epidemic which explained the failure of the health of middle aged working men to improve in the post war period. Table I Whatever gave rise to the postwar discourse on an epidemic of heart disease, which has entered our popular culture with considerable effect, it was not the speeding up of the increase in officially recorded deaths from diseases of the heart. What is obvious from the Table is that the improvement in the health of middle aged men (reflected by the general mortality rate) was getting smaller and smaller. In the 1950s, no-one was going to follow Sir John Simon and take a critical look at industrial conditions. And there was no need, because heart disease had become established as a disease of the affluent working class, a disease of obesity and sloth. One of the important things to remember when puzzling over the statistics of heart disease is how they are produced. The death rates, by age, by region, by occupation and so on, are calculated using certificates returned by thousands of doctors and hundreds of registrars. They have the task of keeping in order the emotionally fraught events that surround the death of an individual. In the 1920s, when important changes in the rules for filling out and coding death certificates were taking place, there was considerable public concern about two things: hidden murders and 'premature burials'. There was even a Society for the Prevention of Premature Burials (15). Any death which took place unexpectedly had to be accounted for. And, of course, deaths during working life are always in some sense unexpected ... they take place before a person has reached his or her alloted span, they are more pathological than natural, explanations may be demanded, blame apportioned. Official health reports in the early postwar period reflect an uncertainty about whether heart disease was (still) on the increase. For example, the Registrar General' s Statistical Review for the year 1951: The steep rise in diseases of the coronary arteries as a certified cause of death in this and other Western countries has provoked much speculation ... That there has been a change in certification habits cannot be denied. There is evidence too of a tendency at times to mention coronary disease as a terminal development during the course of other illnesses or to use the term as a more "precise" description of the cause of death of elderly persons...(16) The Registrar General feels that, notwithstanding all this, it MAY be the cage that changes in 'nomenclature' may have 'concealed, or even originated from, a real increase in the incidence of the disease, the true magnitude of which must remain uncertain.' The Registrar General's solution to this puzzle and to the inadequacy, as he sees it, of existing vital statistics to answer the question, demonstrates very well how, in certain cases, aetiological theories were used to justify the validity of the very statistics use to 'prove' or to 'test' those theories: ... we must try to determine the factors responsible for the occurrence of the disease at the present time -- among which diet, mental stress and lack of physical exercise have come under suspicion -- and judge whether the varying influence of the causative factor or factors can have produced a rising incidence of the disease (17) The logic of this statement is as follows: We think that coronary heart disease has increased because of changes in diet and stress and exercise (because statistics show it to have risen at a time when these other factors here also changing.) But, because we are not too sure of the accuracy of the statistics of the disease, first we need to establish its causes. Then we can see if these causes have increased as well, and judge the accuracy of the disease statistics accordingly. This sort of circular argument attends the entire history of the 'epidemic of heart disease' in various guises. Another problem noted by the Registrar General's Report for 1951 was that: 'Heart disease described in terms such as coronary, myocardial, degenerative, ischaemic, arteriosclerotic and hypertensive or senile are frequently mentioned on death certificates, but it is evident that the same descriptions, though not used indiscriminately ... are often intended to convey different meanings when used by different certifiers. ... it is becoming increasingly urgent to clarify the nomenclature of these diseases in order that the mortality trends can be properly analysed and those cardiac conditions responsible for premature and preventible deaths distinguished from those, if there are such, that are the inevitable concomitants of old age ... (18) The Registrar General's Statistical Review for the year 1956 has a whole section devoted to a study of the accuracy of death certification. A total of 1404 deaths had been studied. A clinician had filled out a death certificate before autopsy, and another certificate was filled out by a pathologist afterwards. 'Arteriosclerotic heart disease' has mentioned in 227 of these, but agreement between clinician and pathologist was reached in only 93 cases. It seems that clinicians were tending to overdiagnose heart disease, in relation to what the pathologist 'saw'. The Registrar General cautions that: In assessing the cause of the disagreement, great attention had to be paid to the use of words and it appeared that the clinician used words suggesting a acute attack more often than was warranted by the facts as revealed post mortem. When they came to certificates stating 'myocardial degeneration' , the researchers found that this term was used 'vaguely' and much more frequently outside of hospitals than inside them. In only one case did the clinician's and the pathologist' s diagnoses agree. The ratio of 'other' myocardial degeneration to 'arteriosclerotic' heart disease in this study was one to ten. In national statistics at that time it was over eight to ten, reflecting what must have been an enormous difference between the attitudes of hospital doctors and general practitioners to the meaning of this term. The final category of cause of death related to the heart in this study was 'other and unspecified diseases of the heart' . Agreement was reached between clinicians and pathologists in only three out of the thirty-six cases so labelled. Two kinds of disagreements arose, one in which the pathologist preferred a more specific diagnosis such as arteriosclerotic heart disease. The second major source of disagreement was: ... the use of words indicating "cor pulmonale" resulted in disagreements of assignments between this rubric and those for chronic bronchitis and emphysema . 8 The Registrar General sums up the findings of this study: A vicious circle seems to be operating. The present state of our knowledge of coronary disease is such that accurate diagnosis and classification is not easily achieved, while at the same time the present classification is probably tending seriously to confuse the issues involved. (19) In 1962, the Chief Medical Officer to the Ministry of Health could still write: Cardiovascular disease ... is pre-eminently a disease of old age. Although dependent upon degenerative changes in the heart the final fatal illness is often precipitated by inclement weather, epidemics of influenza or other infections, so that year to year fluctuations are largely a reflection of such epidemics in the community, just as the long term trend reflects the increasing number of old persons. (20) In his report for the year 1963, the CMO echoes the concern with the health of middle aged men. Life expectancy at age 55 has deteriorated since 1953, and a spell of cold weather had increased the deaths 'attributed to coronary artery disease and arteriosclerosis or other myocardial degeneration. ' (21) Somehow the theory of dietary causation has grown up, in ways that this paper has by no means fully documented, on the basis of mortality statistics which are so readily admitted to be influenced by many things other than a concern to pin down the exact cause of death. A 'community study of heart disease' carried out in the 1960s, provides further examples of this problem. The investigators' aim was to trace every case, fatal or non-fatal, in a limited area (Edinburgh) over a period of about a year and thus to establish 'true incidence' of the disease. They found themselves faced with great problems, for example, in deciding who was a real 'case', especially in cases of 'sudden death', because: ... by this term, some have meant unexpected death either instantaneously or within an hour of the onset of symptoms, whereas others meant death within 24 hours, or even as long as six days. and that: Conventional necropsy alone is a poor method of establishing the cause of sudden death ... Existing pathological techniques do not reveal myocardial infarction with any certainty under about four hours. One cannot justifiably conclude from the presence of extensive coronary atherosclerosis ... that sudden death has been necessarily due to myocardial ischaemia. Existing pathological techniques for the earliest assessment of myocardial infarction leave a lot to be desired. (22) Another similar 'incidence study' in Tower Hamlets, London, reported some even stranger results: ... survivors of possible acute myocardial infarction (MI) (i.e. those in whom diagnostic tests were inconclusive) re-entered the study with definite acute MI at the same rate as those who had survived attacks categorised as definite acute (23) It should be explained that 're-entry to the study' here means returning to hospital with symptoms which this time are accepted as a 'real' heart attack (this includes sudden death). In this study, the factor which discriminated best between those who died of heart attacks and the healthy population of the area was the presence of pre-existing chronic illness. One in six of those aged over 55 who died during the study were not working due to ill health, and one in three of those aged 55-64. These proportions are six times greater than the proportion of the disabled in the general population locally. From this we get a picture of people in middle age, often out of work, usually due to chronic illness, who die (as the Edinburgh group noted) without medical assistance despite 'pre-existing symptoms which passed unnoticed' (24). Orthodox epidemiology has taken it as given that heart disease is the sort of disease that kills 'suddenly', althogh it is admitted that if all persons with chest pain severe enough to be 'suspicious', breathlessness and other associated symptoms, which might be premonitory of a 'heart attack' , were admitted to hospital, existing services would be swamped. A historical approach leads us to turn this orthodoxy on its head and ask rather, when and how did it become necessary for 'unexpected' deaths of persons in the middle and older age groups to be accounted for by assigning them a specific disease category? A glimpse of the process is offered by Greenwood's strange little book on death certification. He complains that: A medical certificate of the fact of death may still (in 1928) be given, and is constantly given, by a doctor who has never set eyes on the presumably dead body ...' (25) In 1923 the Society for the Prevention of Premature Burials, to which Greenwood seems to have been one of the spokesmen, drafted a Bill which was presented to the House of Commons in June 1924. The Bill proposed that all death certificates should be given by doctors who had first been obliged to examine the body. The reaction of the 10 Registrar General and the Ministry of Health was that this would prove 'too expensive'. In the ensuing debate in the House, it emerged that 'only 40% of persons buried in Great Britain at this time were certified on medical evidence actually to be dead.' (26) Greenwood also quoted many coroners' reports from newspapers in support of his contention that death certificates, far from being an accurate reflection of the cause of death, were not even an accurate record that death had occurred. For example, this from the Westminster coroner, quoted in the Sunday Times January 14 1923: Doctors . .. commonly certify when they have not seen the deceased for months ... these certificates are mere guesses at the cause of death, are generally given to save trouble and to please the relatives ... One case was certified as 'natural death from heart disease' when the dead man was found to have a dagger through his heart! (27) These passages are merely some of the most striking amongst a great deal of evidence that unexpected and/or premature deaths became the sort of event that could be neatly dealt with by attributing them to such as entity as 'coronary' heart disease. Granting death certificates is essentially an administrative process, part of the way in which medicine patrols the borders of social normality and preserves certain images of the social order. And yet, the administrative process generates a set of statistics which are used to try and discover the 'causes' of something which has been thereby constituted as a unitary biological phenomenon. As people expected to live longer, death became a pathological rather than a normal event at a later and later phase in the life history. As the power of workers' organisations to gain compensation for industrial illness and deaths grew, it became necessary to account for the early death of many workers in heavy and dirty industries. The idea that a miner or a labourer 'wore out' ('degenerated') faster than a vicar or a teacher has no longer just part of the natural order. It needed to be explained in terms of a disease. A contemporary example of this process in action is brilliantly given by Max Atkinson in a book on suicide: Towards the end (of the autopsy), the coroner's officer asked the pathologist; "Well, have you found anything for me?" ... The pathologist had paused after the question and had picked up the heart of the deceased which he seemed to be examining closely . .. (he) looked up from his examination of the heart and said: "Well, I'd like to give you 'shock' -- 'shock' in the medical sense that is, because the shock of the operation is what really stopped his heart beating, but this coroner doesn't like 'shock' does he?" The coroner's officer confirmed that this was indeed that case, 11 to which the pathologist replied: "I could give you 'heart failure' then, how would that be?" "That'll do me fine," replied the coroner's officer. (28) In the past two or three years, the pillars of the medical profession have trembled slightly under the impact of a growing debate on the quality of death certification. A Committee on Medical Aspects of Death Certification was set up jointly by the Royal Colleges of Pathologists and Physicians, which reported in 1982. Their report helps us to see how the record-keeping procedures of the practice of medicine produce 'rates of mortality' which must still be heavily dependent upon the practical needs of clincial medicine in hospital and community, rather than upon the needs of epidemiological research. There are .. certain administrative matters which allow or even encourage inaccurate certification. The certification of death in hospital is usually done by the most junior doctors ... furthermore, they may avoid any mention of septicaemia or alcohol related disorders because they know that if these words appear on the death certificate ... the coroner will become involved. Many doctors ... are aware that certain items on the certificate attract the attention of the local registrar and lead to a death being referred to the coroner. With this knowledge, they avoid the use of such terms. The extent of this practice is not known. (29) "Certain items" in this context include industrial disease. H.M. Cameron and E. McGoogan, two leading pathologists, one of whom sat on the joint Committee quoted above, had previously published a paper on the results of a series of autopsies carried out in a major British hospital. They concluded: There is little doubt that myocardial infarction and its abbreviation 'AMI' are commonly used as convenient labels when the cause of an unexpected death is not known ... in general practice, the diagnosis of coronary artery disease is little more than guesswork, and it is likely that guesswork is not confined to general practice.' ... 'In our experience, statistics from death certificates are so inaccurate that they are unsuitable for use in research and planning. (30) In Cameron and McGoogan's study, AMI and 'arteriosclerotic heart disease' (ASHD) were two of the most commonly 'overdiagnosed' diseases (i.e. most likely to appear on pre-autopsy death certificates and fail to be confirmed pathologically). They propose that 'Routine autopsies on cases with these clinical diagnoses' should be carried out to check for the presence of other conditions, particularly rheumatic heart disease (the old disease of poverty), and gall bladder disease and 12 peritonitis (which, as causes of death in hospital, might be described as diseases of neglect). It is not the contention of this paper that people have been dying of heart disease 'caused' by poverty, industrial hazards or unemployment and other stresses, any more than that their illness has been caused by obesity and sloth. Rather, I mean to question whether we can even go so far as to talk about a modern 'epidemic of heart disease' at all, without a far more careful historical analysis of how death certification and the production of health statistics play a role in maintaining a social order at different periods in time. The pattern of material deprivation, poor working conditions, low pay, persistent chest pain (whether attributed to heart or lungs) and other forms of chronic illness, co-existing with early death, seems to have remained with us. It is illustrated in the social class, occupational and regional mortality differentials, and is commented upon by official government spokesmen on health and independent researchers throughout the period 1900-1980. During this period, ideas about disease entities and their aetiology have undergone major changes. Mali can be seen now, in the current health education orthodoxy, as described by Wendy Farrant and Jill Russell (31) is the political importance of a major disease category and of the causal theories which seem to arise 'naturally' and inevitably out of the definition of the disease itself. If we accept the entity 'coronary heart disease', we have already conceded half the case for the existence of an 'epidemic' caused by affluence and declining levels of physical activity. It is not enough to ask 'what are the social factors in the causation of coronary heart disease?' -- and thereby leave to the medical profession the major initiative in defining disease categories, whilst accepting the ancillary task of slipping in a few social or historical bits here and there. The historical evidence demands that we suspend the assumptions behind conventional diagnostic categories and locate, not just the 'causes', but also the diseases themselves in their social and historical context. ACKNOWLEDGEMENTS This paper could not have been written without many discussions with colleagues and friends which took place before and during the process, particularly Karl Figlio, David Blane and Norman Weinstock. I am also very grateful for detailed comments and extensive encouragement and guidance from Celia Davies. REFERENCES (1) J.A. Ryle and W.T. Russell, 'The natural history of coronary heart disease - a clinical and epidemiological study, 'u u 1949 (11) 370-389 (2) M. Oliver, 'Does control for risk factors prevent coronary heart disease' u (285) 1065-1066 13 (3) Ministry of Health - u u u u u u u u u u u u u u u u u u (HMSO 1923) p 15 (4) ibid, p 16 (5) ibid, p 16 (6) Ministry of Health - u u u u u u u u u u u u u u u u u u (HMSO 1926) , p 55 (7) u u u u u u u u u u u u (HMSO 1932) p 85-86 (8) u u u u u u u u u u u u (HMSO 1932) p 67-68 (9) Ministry of Health - u u u u u u u u u u u (HMSO 1934) p17 (11) W.P.D. Logan, 'Mortality in England and Wales,' u u 1950 (4) 132-178 (12) Ministry of Health - u u u u u u u u u u u (HMSO 1934) p 206, 252 (13) Charles Webster, 'Healthy or hungry 'thirties?' u u u April 1982 (13) p 110-129 (14) Sources: Logan op. cit and u u u for the years 1951, 1961, 1971 (15) Sir George Greenwood - u u u u u (Published on behalf of the Society for the Prevention of Premature Burials, Oxford University Press, 1928) (16) u u u u u u u u (HMSO 1954) p 218 (17) ibid p 218 (18) ibid p 218 (19) u u u u u u u u (HMSO 1958) p 188-191 (20) Ministry of Health - u u u u u u u u u u u (HMSO 1963) p 25 (21) Ministry of Health - u u u u u u u u u u u (HMSO 1964) p 23 14 (22) M. Fulton et. al., 'Sudden death and myocardial infarction,' u (Suppl. IV vols XIX-W) 1969 p (IV) 1 82 - (IV)193 (23) H. Tunstall-Pedoe eli. al. 'Coronary heart attacks in East London,' u 1975 (ii) 833-838 (24) Fulton et. al., op. cit. (M) Greenwood, op.cit., p 14 (26) ibid., p 14 (27) ibid., p 20 (28) J.M. Atkinson - u u u u u u u u u u (Macmillan, London, 1978) p. 98 (29) joint Committee of the Royal Colleges of Physicians and Pathologists, 'Medical Aspects of Death Certification,' u u u u u u u u u 1982 (16) 205-218 (30) H.M. Cameron and E. McGoogan, 'A prospective study of 1152 hospital autopsies. I: Inaccuracies in death certification, 'u u u 1982 (133) 273-283 (31) Wendy Farrant and Jill Russell - u u u A Cas e Study on the Production of Health Education Council Publications (institute of Education Health Education Publications Project, unpublished monograph 1983)