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.
<uBefore Workmen's Compensation>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 <uPriestley>u v. <uFowler>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 <uPriestley>u v.
<uFowler>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 <uPriestley>u v. <uFowler>u must emphasise
both the difficulties facing the injured and the likelihood that many
masters made at least some reparation to injury parties.
<uPriestley>u v. <uFowler>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 <uPriestley>u
v <uFowler>u, the courts developed three so-called legal 'fictions' :
common employment, contributory negligence, and <uvolenti non fit injuria>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
<uPriestley>u v. <uFowler>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 <uPriestley>u v. <uFowler>u and a later American
case, <uFarwell>u v. <uBoston and Worcester Railroad-Corporation>u,10 the
Court of Exchequer introduced the doctrine of common employment to
English soil in <uHutchinson>u v. <uYork, Newcastle and Berwick Railway Co.>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.<s13>s The third 'fiction' was that of <uvolenti non fit injuria>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 <uvolenti>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.<s14>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.<s15>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.<sl6>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 <uvolenti>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.<s17>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.<s18>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.<s19>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.<s20>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.
<uThe Workmen' s Compensation Act>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.<s21>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' .<s22>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.
<uThe System at Work: Dimensions>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.<s23>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 <usuccessful>u claim for compensation. Hence, on average
there was a strong possibility that in the course of a working life
<uTable 2.1>u <uStatistics of Compensation in the Seven Industries, 1919-1938>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' .<s24>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.
<uThe System at Work: Problems and Issues>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 <uLaw Times>u which,
in 1928, called benefit scales (revised by Parliament in 1923)
'tragically inadequate' .<s25>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 ' .<s26>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'.<s27>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.<s28>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.<s29>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.<s30>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'.<s31>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?).<s33>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
<uKitchenham>u v. <uOwners of S. S. Johannes burg>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'.<s34>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 <uHansard>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' .<s35>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. <s36>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.<s38>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.<s39>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.<s40>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.<s41>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 raised<s4>s in Parliament intermittently for the remainder of the
thirties.<s42>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.<s43>s
A Home Office minu of 1922 recognised that companies' premium
rates were a 'scandal'.<s44>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.<s45>s <uThe Times>u feared that the agreement threatened insurance
companies probability.<s46>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.<s47>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'.<s48>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.<s49>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' .<s50>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.<s51>s Indeed, the government
subsequently discounted Beveridge' s view.<s52>s In safety terms the
Workmen' s Compensation Acts must be judged to have failed.
<uConclusion>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.
<uNotes>u
1. Much of the early part of this paper is based upon P.W.J. Bartrip
and S.B. Burman, <uThe Wounded Soldiers of Industry. Industrial>u
<uCompensation Policy, 1833-1897>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' , <uSociety for the Study of Labour History Bulletin>u,
vol. 32 (1976), pp. 20-22. See also P.E.H. Hair, 'Mortality
from Violence in British Coal Mines, 1800-50' , <uEconomic History>u
<uReview>u, 2nd Ser. , vol. XXI (1968) , pp. 545-61. Some of these
issues are discussed in chapters 1 and 2 of Bartrip and Burman,
<uThe Wounded Soldiers>u.
3. <uParliamentary Papers>u (hereafter <uPP>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. <uLincolnshire Chronicle and General Advertiser>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, <uThe Origins of Modern English Society, 1780->u
<u1880>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 <uPP>u 1841 X, Report
of Inspector Howell, pp. 167-69; Bartrip and Burman, <uThe Wounded>u
<uSoldiers>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 <uGroves>u v.
Wimborne (1898) 2 Q.B. 401, <uLochgelly Iron and Coal Co.>u v. <uM'Mullan<u
F(1934). C. 1 and <uWilsons & Clyde Coal Co. Ltd>u. v. <uEnglish>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' , <uModern Law Review>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, <uThe Wounded Soldiers>u, p. 76; <uPP>u 1873 XIV,
Select Committee on the Regulation of Railways (Prevention of
Accidents Bill) , Evidence, pp. 587-88.
15. <uPP>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, <uThe Wounded Soldiers>u, pp. 158-73; J. & B.
Webb, <uIndustrial Democracy>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 <uHansard>u 8 (20 Feb. 1893) c. 1961.
19. See <uPP>u 1846 XIII, Select Committee on Railway Labourers, Evidence,
pp. 585-89; E. Chadwick, <uPapers read Before the Statistical>u
<uSociety of Manchester,on the Demoralization and Injuries Occasioned>u
by the Want of Proper Regulation of Labourers Engaged in the>u
<uConstruction and Working of Railways (London, 1846), pp.18-19.
See also, R. A. Lewis, ' Edwin Chadwick and the Railway Labourers ' ,
<uEconomic History Review>u, 2nd Ser., III (1950) pp. 107-18.
20. See Reort of the TUC Parliamentary Committee ' in <uTUC Proceedings >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',
<uJournal of Economic History>u, vol. X (1950) p. 57.
23. Throughout this is section statistics are drawn from annual Home
Office compilations published as Parliamentary Papers.
24. <uBalfour Committee on Industry and Trade. Factors in Industrial>u
<uand Commercial Efficiency. Being Part 1 of a Survey of>u
<uIndustries, FInal Report>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, <uThe Workmen's Compensation Acts 1897>u
<uand 1900>u, 2nd ed. (William Clowes, London, 1902) p. v.
32. <uHoddinott>u v. <uNewton, Chambers & Co.>u [1901] A.C. 63.
33. A.H.Ruegg, <uThe Laws Regulating the Relations of Employer and>u
<uWorkmen in England>u (William Clowes, London, 1902) P. 151.
34. [1911] A.C. 410.
35. See, for example, Sir A. Wilson and H. Levy, <uWorkmen's Compensation>u
(2 vols. , London, 1939) , I, p. xiv; G. Howell, <uLabour Legislation>u,
<uLabour Movements and Labour Leaders>u (2 vols. , T. Fisher Unwin,
London, 1905 edn.), vol. 2, p. 432; V.R. Aronson, <uThe Workmen's>u
<uCompensation Act 1906>u (London, 1909), p. 17; <uDerbyshire Times,>u
3 Dec. 1898; <uThe Times>u, 4 Oct. 1898 and 24 July 1899.
36. 'Industrial Law', <uLaw Quarterly Review>u, vol. 51 (Jan. 1935) pp.
197-98; see also his 'Industrial relations and the State: A Reform
of Workmen's Compensation', <uPolitical Quarterly>u, vol. 1 (1930) pp.
511-30, and W.A. Robson (ed.), <uSocial Security>u (George Allen and
Unwin, London, 1943) p. 13.
37. S.H. Noakes, <uButterworths' Digest of Leading Cases on Workmen's>u
<uCompensation . . .>u (Butterworth & Co., London, 1933).
38. See, for example, <uPP>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; <uPP>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'. <uPP>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; <uPP>u 1933-4,
XXVI, Statistics ... 1933, pp. 1271-72. See 5 <uHansard>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 <uHansard>u 212 (20 May 1936) cc. 1197-8.
43. <uPP>u 1920, XXVI, Departmental Committee on Workmen's Compensation,
Report, pp. 13-16.
44. PRO PIN 11/7, dated 3 Jan. 1922.
45. <uPP>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 <uThe Times>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; <uBalfour Committee, Final Report>u, p. 256.
46. 16 June 1923.
47. 'Industrial Law' , p. 198; see also Robson, 'Industrial Relations',
pp. 511-30; E.H. Downey, <uWorkmen's Compensation>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, <uWilliam Beveridge. A Biography>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. <uPP>u 1920, XVI, Department Committee on Workmen's Compensation,
Report, p. 67.
50. <uPP>u 1904, LXXXVIII, Departmental Committee Appointed to Inquire
into the Law Relating to Compensation for Injuries to Workmen,
Report, p. 749.
51. <uPP>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. <uPP>u 1943-4, VIII, Workmen's Compensation. Proposal for an Industrial
Injury Scheme, p. 532.
What is an Accident?
Karl Figlio
<uINTRODUCTION>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, <uas if>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.
<uAccidents and the Contract-Form of Employment>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, <uBlackstone' s Commentaries>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(malfeasance)>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 - <uassumpsit>u - began to
apply to cases of not doing (nonfeasance), as well as to
<umalfeasance>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.
<uEvents as Acts>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.
<uNonfeasance>u could harm, and lead to legal action, just as
<umalfeasance>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.
<uLiability in the Master/Servant Relationship>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 <uPriestley>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 <uform>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
<uPriestley vs. Fowler>u), he or she took on the associated
risks and the responsibility to judge them (22).  The case of
<uFowler vs. Lock>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
<uPriestly vs.  Fowler>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,
<ui.e.>u  for <unonfeasance>u.  With this latter change, we see
the esscence of the contractual relationship, which established
the possibility of an accident (28).
<uNegligence and the Implied Contract>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 <uvolenti>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 <uFowler vs. Lock>u (the case of the
cab-and-horse  hiring)  and <uRobertson vs. Amazon Tug and>u
<uLighterage Co.>u will illustrate this distinction between
conditions which breach a contract and those which do not (36) .
In <uFowler>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 <uRobertson>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
<uFowler>u, but lost, because the <uparticular>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 <uFowler>u negligently
breached his contract; the bailor in <uRobertson>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 <unovus actus>u
<uynterveniens.>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.
<uNature, Facts and the Contract>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'volenti'>u (<unon fit injuria>u) clause.
  The <uvolenti>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 <uvolenti>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 <uvolenti>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 <unatural>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 <uDunham vs.. Clare>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 <uDunham vs>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 <uDunham vs. Clare>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 <unonfeasance>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.
<uThe Accident Model of Disease>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.
<uSummary>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.
<uReferences>u
1.  The classic treatment of workmen's compensation is A.
Wilson and H.  Levy,  <uWorkmen's Compensation>u (2 Volumes,
Oxford University Press, Oxford, 1935/9.  On the political
evolution of the Act, see P. Bartrip and S. Burman, <uThe>u
<uWounded Soldiers of Industry:  Industrial Compensation Policy>u,
<u1983-1897>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.) <uThe Problem of Medical Knowledge:  Examining the>u
<uSocial Construction of Medicine>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, <uCrowner's>u
<uQuest>u This monographi is <uTransactions of the American>u
<uPhilosophical Society>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 <uLaw of Contract>u 9th edn.,  by M.  Furmston
(Butterworth, London, 1976).
5.  Pelling, 'Medical Practice in the Early Modern Period:
Trade or Profession?'  <uBulletin of the Society for the Social>u
<uHistory of Medicine>u No. 32 (1983) 27-30; a fuller version is
forthcoming in <uKos.>u
6.  <uBlackstone's Commentaries on the Laws of England>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,
<uThe Law Dictionary>u  (2 Vols. London, 1820). E. Umfreeville,
<uLex Coronatoria>u (London, 1761), pp. 4S0ff. does have a
section 'Accidents, Casualties, etc. as well on land as by water'.
8.  E. Jenks, <uA Short History of English Law>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.)  <uThe Problem of Medical>u
<uKnowledge>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, <uCrowner's Quest.>u
13.  <uBlackstone's Commentaries>u Vol. 1, pp. 300-1.  T.
Forbes, <uCrowner's Quest>u,  p.  7.  W.  Wescott,  'A Note Upon
Deodands', <uTransactions of the Medico-Legal Society of>u
<uLondon>u 10 (1910),  91-7.  <uCoroner's Guide . . .  Containing>u
<uPrecedents and Instructions ...>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 <uCrowner's Ouest,>u pp. 1-6; ERO, D/DP E188 f39.
16.  ERO, CR/S1
17.  Umfeeville, <uLex Coronatoria>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' ,  <uColumbia>u
<uLaw Review>u 67 (1967) 50-82, esp. pp 54-6.
21.  C. Addison <uTreatise on the Law of Contract>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,  <uThe Experience of Labour in l8th-Century>u
<uIndustry>u (Croom Helm, London, 1981), p. 87.
25.  A. Smith, <uAn Inquiry into the Nature and Causes of>u
<uthe Wealth of Nations>u (l9776) (Penguin,  Harmondsworth,  1974),
BR.  1,  Ch.  10,  Pt.  1.
26.  H. Broom, <uCommentaries on the Common Law>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, <uThe Foundation of the Law>u
<uof  Tort>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"Volenti Non Fit Injuria">u:  'That to which a person
assents is not esteemed in law an injury. '  H. Broom, <uA>u
<uSelection of Legal Maxims ...>u  3rd  edn.  (W.  Maxwell,  London,
18580) pp. 245-54. On <uVolenti>u after the Act, see C. Addison
<uTreatise>u,  2nd edn.  (London,  1983).  I will discuss
<uVolenti>u in more detail later.
33.  C. Addison, <uTreatise>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,  <uWillis's  Workmen's  Compensation Acts>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,  <uCausation in the Law>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
<uSurgeon in the State Regulation of Child Labour and Industrial>u
<uHealth, 1833-1973>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, <uDiseases and Mortality of>u
<uOccupations>u (Percival, London, 1892).
56.  Iid., 21 ff.
57.  D. Blane, 'Inequality and Social Class' in D. Patrick and
P.  Scambler (eds),  <uSociology as Applied to Medicine>u
(Bailliere and Tindall, London,  1982) pp.  113-24. J.  Fox and A.
Adelstein, 'Occupational Mortality:  Work or Way of Life',
<ujournal of Epidemiology and Community Health>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, <uInequalities in Health:  The Black>u
<uReport>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, <uThe Civilized>u
<uBody:  Social Domination, Control and Health>u (Temple University
Press, Philadelphia), 1982.
<uAcknowledgements>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 <uReich>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.
<u1. The Innovative Phase of State Social Policy>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 <uKaiserreich>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 <ucarte>u <ublanche>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 <uVerein fur Sozialpolitik>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 <udoctors>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 <uVerein>u <ufu%r>u
<uSozialpolitik>u and by the <uReichstag>u, ordered a <uReichstag>u
<u-Enquete>u on womens' and children's labour.  They strongly re-
commended such an inquiry not only to the <uReichskanzleramt>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 <uReichs-Enquete>u on women's and children's work vividly
illustrated on how injuri-ous to health most industries were
which employed women. The <uEnquete>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 <uReichskanzler>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
<uReich>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 <upossibilities>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.

<u2. The Restrictive Phase>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 <uReichskanzleramt>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 <uReichstag>u in the spring of 1877, when the
<uReichskanzleramt>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 <uReichstags>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
<uReichstag>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 <uReich>u trade code. The <uReichstag>u had also
handed over competence in this sphere to the cabinet (<uBundes>u-
<urat>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
<uReichskanzleramt>u drafted on this theme in the years from 1881
to 1884 were by no means due to the political genius of the
<uReichskanzler>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 <uReich>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 <uReichsge>u-
<usundheitsamt>u, established shortly before in 1876, should nomi-
nate the factory inspectors, because "precisely the professional
class represented in the <uReichsgesundheitsamt>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 <uadministration>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."<s1>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. "<s2>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.<s3>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.<s4>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.<s6>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.<s8>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.<s9>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.<s11>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.<s2>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".<s133>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.<s14>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".<s15>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". 1<s6>s


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."<s17>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 <uLancet>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.<s20>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".<s22>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".<s23>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".<s27>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'.<s25>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).<s26>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.<s27>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.<s28>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".<s29>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.<s30>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".<s31>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".<s32>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 <usame>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".<s33>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.<s34>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 <ualso>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

<uYear>u      <uMen>u         <uWomen>u         <uMen>u          <uWomen>u

     <uCases>u  <uDeaths>u <uCases>u <uDeaths>u <uCases>u <uDeaths>u    <uCases>
u <uDeaths>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.<s36>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, <uinter>u
<ualia>u, that all their inside organs would turn yellow
and that they would not be able to have children,
etc."<s37>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 <uWoman Worker, "We do not recommend our
members to refuse work on explosive".<s38>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." <s39>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."<s40>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.<s41>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.<s42>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 had<s2>s 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".<s43>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.<s45>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. <s46>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.<s47>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."<s48>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 <urelatively>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.<s49>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.<s50>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.<s51>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.<s52>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 <unecessary>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", <uBritish Medical>u
<uJournal>u, 17 May 1919, 708, and Medical Research Council,
<uTNT Poisoning and the Fate of TNT in the Animal Body>u, Special
Report Series No.58, HMSO, 1921, 5.

2. <uHistory of the Ministry of Munitions>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, <uHealth of t>uhe
<uMunition Worker>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", <uThe Lancet>u,
12 Aug. 1916, 261.

11. Ministry of Munitions , "Trinitrotoluene Poisoning", <uThe Lancet>u,
16 Dec. 1916, 1027.

12. MRC 1921.

13. Editorial <uThe Lancet>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
<uSarnbow>u no.l (Leeds) National Filling Factory, unpublished
n.d. 45.

15. MRC, 1921, 16.

16. Health of Munitions Workers' Committee <uFinal Report, Industrial>u
<uHealth and Efficiency>u, 1918, Cd 9065, 78.

17. B. Moore, letter writing earlier work, <uBMJ>u, 4 Aug. 1917, 164.
<s13.>s MRC (Committee) Special Report Series no.11, <uThe Causation>u

<uand Prevention of Tri-Nitro-Toluene>u (TNT) Poisoning, HMSO
1917, 47.

19. Ministry of Munitions, "Trinitrotoluene Poisoning", <uBMJ>u
16 Dec. 1916, 844.

20. <uThe Lancet>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, <uTrade Unionism and Munitions>u, Oxford, 1923.

28. Health of Munition Workers Committee, Memo no.4, <uThe Employment>u
<uof Women>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. <uThe Crisis>u, 1920.

32. IWM, MUN 19, Armstrong-Whitworth's

33. The Congress Report, 1919 cit Gr. Braybon, <uWomen workers in the>u
<uFirst World War>u, 1981, 199.

34. Women's Trade Union Review.

35. A. Anderson, <uWomen in the Factory>u, 1922, 307.
IWM, MUN <s342>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. <uWoolwich Pioneer>u, 16 Feb. 1917
<uWomen Workers>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 34<s2>s

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 <uReeves>u, <uRound About a Pound a Week>u, 1911,
demonstrates
income households.

51. Health of Munition Workers Committee Handbook <uThe Employment>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"Infortunello>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 <uactive>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. (<s24>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(25)>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(26)>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(27)>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(28)>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(29)>s Evidence from the factory archive does , however, reveal th
at
the workers fears were not unfounded. In 1933, a memorandum to the <sAmministrat
ore>u
<uDelegato>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(30)>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(42)>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 <urational organisation>u. In the eyes
of both the management and the workers the link between scientific management
and accidents is perfectly clear. " (his italics) <s(43)>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(44)>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
<usolely due to the safety measures>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(48)>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(49)>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.
<uReferences>u

1. The Magneti Marelli was described as a "golden factory " (<uuna fabbrica doro
>u)
by a former Winding Shop worker employed there from 1933. Interview with
Gregnanin Maria, December 1983.
2. L.Devoto,<uLa Clinica del lavoro di Milano 1910-1929>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.), <uSalute e classi lavoratrici in Itali
a>u
<udall'Unita al fascismo>u (Franco Angeli, Milano, 1982)p. 145.
4. <uIbid>u., p.143.
5. For more information on social insurance legislation see, A. Cherubini <uStor
ia>u
<udella previdenza sociale in Italia 1860-1890>u (Editori Riuniti, Roma, 1977) a
nd
G.Bronzini, 'Legislazione sociale ed istituzioni corporative' <uin Annali>u
F<ueIlrinelli 1979-80 >u Feltrinelli,M ilano 1981)
6. A.Carbonini, 'Luigi Devoto e la clinica del lavoro di Milano' in Betri and
Gigli Marchetti, <uSalute e classi lavoratrice>u, p.515.
7. L.Devoto, "La clinica delle malattie professionali degli Istituti clinici
di Milano', in <uAtti del 1 Congresso internazionale per le malattie del lavoro>
u,
cited in <uIbid>u., p.515.
8. L.Devoto, <uI venticinque anni della clinica del lavoro di Milano>u, (A. Cord
ani,
Milano, 1935), p.19.
9. L.Devoto, "Una disciplina italiana e i trenta anni del suo giornale ' <uLa>u
<uMedicina del Lavoro>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 <uAnnali Feltrinelli 1979-80>u, p.232.
10. Dodi Osnaghi, 'Aspetti', p .234.
11. G.Sapelli, <uOrganizzazione, lavorc e innovazione industriale nell'Italia tr
a>u
<ule due guerre>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,
<uSalute e classi lavoratrice>u, p.871.
13. Sapelli, <uOrganizzazione>u, p.375.
14. <uIbid>u., p.372.
15B. Bianchi, 'I tessili : lavoro, salute, conflitto' in <uAnnali Feltrinelli.>u

16. G. Consonni and G.Tonon, "Milano: classe e metropoli tra due economie di gue
rra',
in <uIbid.>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, <uOrganizzazione>u, p. 377.
19. Various articles in the factory newspaper, <uSprazzi e Bagliori>u ('Sparks a
nd
Glows', hereafter <uSB>u) describe the Safety Committee. For example, A. Corregg
iari,
"Esperimenti Antifortunistici', <uSB>u, gennaio 1929. pp. 25-31.
20. Unsigned memorandum, c . 1935. <uAPMM>u fasc. Sigurta Adelina.
21. "In casa nostra', <uSB>u, maggio 1929, p.51.
22. <uIbid>u.
23. The level of education is shown on most of the APMM files.
24. Both articles in <uSB>u and notes in APMM mention workers who have suggested

safety modifications.
25. Sapelli,<uOrganizzazione >u,pp .361-2.
26. G.Sapelli, 'Formazione della forza lavoro e psicotecnica nell 'Italia fra le

due guerre mondiali', <uQuaderni di Sociologia >u,No.1,1977,p.21.
27. M.Fossati 'La selezione del personale in una azienda industriale di grande
importanza '(prima parte) ,<uSB>u,giugno 1927,p.24.
28. Fossati 'La selezione'(seconda parte)<uSB>u,luglio 1927,pp .21-22.
29. U.Quintavalle , "L"Indugtria e la lotta contro la tubercolosi " ,<uL 'Assist
enza
<usociale nell'industria>u,Nov.-Dic.,1928.p.8.
30. Letter with illegible signature ,24 March 1933.<uAPMM>u. Fasc. Russo Frances
co .
31.'Per difendere gli operai' ,<uSB>u,giugno 1929,p.52.
32. A.Correggiari, "La prova dei fatti " ,<uSB>u,gennaio 1930,p.45.
33. Ibid.
34. Ibid.,p.47.
35. The materials contained in the <uAPMM>u are generally much richer for the 19
30s
than for the preceding period.
36. Dodi Osnaghi, 'Aspetti' ,p.274n .
37. <uAPMM>u, fasc. Imberti Aristide.
38. E.g. the cases of Magni Carmela and Moretti Ambrogio ,<uAPMM>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,
<uAPMM>u,fasc. Galbiati Francesco.
42. H.Ford,<uMy Life and My Work>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',<uSB>u,luglio 1925,p.11.
46. Correggiari, 'La prova dei fatti',p.46.
47. <uIbid>u.,p.47.
48. Vico d'Incerti. 'La lotta contro gli infortuni',<uSB>u,marzo-aprile 1938,p.3
7.
49. 'Rapporto sulla situazione organizzativa della Federazione di Milano' ,Milan
o,
    20 aprile 1944,in A.Scalpelli,<uScioperi e guerriglia in Val Padana( 191943-
45>u),
    (Argalia Editore,Urbino, 1972) p.95.
50. 'Assistenza sociale',p. 11.
51. <uIbid>u.
<uDISEASE,LABOUR MIGRATION AND TECHNOLGICAL CHANGE: THE>u
CASE OF THE CORNISH MINERS.>u
<uGill  Burke>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 <uHealth of Cornish>u
<uMiners>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 <uWorkmans Compensation Act>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 <uRoyal>u
<uCommission on the Poor Laws>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 <uAnkylostoma Duodenale>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
<uTrichocephalus>u rather than the much more common <uTaenia>u
<uSolium>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
<urisk and manifestation of the disease, Compensation for>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.
<uReferences>u
1.  Burke G.M. <u'The Cornish Miner and the Cornish Mining>u
<uIndustry 1870-1921>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' .
<uBusiness History>u XXIII no 1  (1981) P4.
3. Parkes W.R. <uOccupational Lung Diseases>u (London) 1974
pp 166-216
4. Burke G 'The Cornish Diaspora of the l9thC' in S Marks
and P Richardson (Eds) <uInternational Labour Migration :>u
<uhistorical perspectives>u (London) 1984 pp
S.PP 1904 xiii (Cd 2091) <uReport on the Health of Cornish>u
<uMiners>u
6. Burke G and Richardson P The Profits of Death: a
comparative study of Miners' Phthisis in Cornwall and the
Transvaal 1876-1918' <uJournal of Southern African Studies>u
Vol 4 no 2 1978 P 149
7. PP 1909 <uRoyal Commission on the Poor Laws>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. <uA Short Text Book on Preventive Medicine in>u
<uthe Tropics>u (London) 1976 pp 132-137
10 PP 1903 XV (Cd 1671)  <uThe Epidemic of Ankylostomiasis in>u
<uthe Westphalian Colliery District>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. '<uJournal of Hygiene>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'. <uJournal of Hygiene>u Vol 4. 1904 pp 477-479
13. ibid P 479.
14. PP 1902 XVII (Cd 1318) <uReport on an outbreak of>u
<uAnkylostomiasis in a Cornish Mine>u by J. S. Haldane.
  <uTuberculosis, Silicosis, and the Slate Industry in North Wales>u:
<uMedical Examinations into the High Tuberculosis Death Rates in>u
<uthe North Wales Slate Mining and Quarrying Districts, 1927-39.>u
  The slate industry had become a commercial enterprise in
the counties of Caernarvonshire and Merionethshire in North Wales
by the mid-eighteenth century. <s1>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.<s2>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.<s3>s A recent
study of the health of the workers in the industry by J. R. Glover
<uet al>u., published in 1980, showed pneumoconiosis to be very
prevalent.<s4>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. <s6>s This was followed by a survey by Drs C. H.
Sutherland and S. Bryson of the Mines Department in 1930,<s7>s and by
Dr Q.D. Chalke of the King Edward VII Welsh National Memorial
Association in  1933.<s8>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.<s9>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.'<s10>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.'<s11>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.'<s10>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. '<s11>s  However,  such statements,
increasingly charged with political implications,<s12>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.<s13>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.<s14>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.<s15>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.<s16>s The two counties of
Caernarvonshire and Merionethshire had the highest death rates
from tuberculosis of all counties in England and Wales in 1932.<s17>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 <umicobacterium tuberculosis>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;<s18>s by 1920
there were 388 institutions providing for tuberculosis patients
as well as 398 dispensaries.<s19>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.<s20>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).<s21>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.'<s22>s The Association argued that the increased
expenditure was necessary and justified, and they demanded an
inquiry into the tuberculosis services in Wales.<s23>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.<s24>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.<s25>s
  Wade's analysis of slate dust showed up to fifty per cent
quartz content.<s26>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.<s27>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.<s28>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 <uWestern Mail>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...'<s29>s However, the majority of the medical profession
practising in the area did not accept Wade's results.<s30>s One
doctor he interviewed was definitely of the opinion that slate
dust was not harmful but beneficial.<s31>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.<s32>s It was reported in the <uSlate Trade>u
<uGazette>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.'<s33>s
  They concluded with the warning that continued impositions and
  interferences by the state meant the diminution of capital and
  more unemployment.<s34>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,' <s35>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.<s36>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.<s37>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.<s38>s S. Lyle Cummins professor of
  Tuberculosis and Consultant to the Association, prepared a
memorandum on the subject.<s39>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.<s40>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.' <s41>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.<s42>s 0ne suggestion was that the money spent on dust
allaying experiments, limited though these were,<s43>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,<s44>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,<s45>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.<s46>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.<s47>s Following the
publication of Davies' evidence in 1939,<s48>s  slate miners were
included in the Silicosis Scheme of the Workmen's Compensation
Act.<s49>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.<s50>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 <uTimes>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.'<s51>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.<s52>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.<s53>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.<s54>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.'<s55>s
  Discussing Chalke's 1933 report,  an article in the
<uLiverpool Post and Mercury>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'.<s56>s Chalke had started to plot family
infection, as Dr R. C. Hutchinson had done in a survey in
Carmarthenshire,<s57>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.<s58>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.<s59>s Another doctor from the area also referred to
inter-marriage among members of tubercular familes as leading to
increased tuberculosis in this area.<s60>s <uThe 29th Annual Report of>u
<uthe Caernavonshire Joint Sanitary Authority>u, 1936, recommended a
voluntary examination of each prospective partner before entering
matrimony.<s61>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'.<s62>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.<s63>s Tomley mentioned the refusal of the people
to open their doors to the tuberculosis officer because of the
stigma attached to the disease.<s64>s According to the <uCambrian News>u
<uand Welsh Farmers Gazette>u, 'Even mentioning the name of the
tuberculosis physician was sufficient to frighten some persons
into saying "no" [to  examination].' <s65>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,<s66>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.<s67>s
Moreover, this fatalistic response to tuberculosis was not unique
to the inhabitants of Wales; tuberculosis officers in England
were reporting the same difficulties.<s68>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.<s69>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.<s70>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.<s71>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.'<s72>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. <s73>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.<s74>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.<s75>s Dr John Jones of Dohgelly agreed; the
people in these days did not eat proper food.<s76>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. <s77>s Dr Hawkins and Dr Rowland Williams of
Pembroke believed malnutrition in the majority of cases was due
to ignorance.<s78>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.<s79>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].'<s80>s Chalke, however,
believed that 'bad tradition' had existed for centuries.<s81>s.  A
1893 committee of inquiry had shown that the workers lived at
that time mainly on bread, butter and tea.<s82>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.<s83>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'.<s84>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.<s85>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.'<s86>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.<s87>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.'<s88>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.<s89>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.<s90>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.<s91>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.<s92>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.<s93>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.<s94>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. <s95>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.<s96>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.<s97>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' <s98>s.
                     12
 <uFootnotes>u
  1. For the most recent histories of the industry and the area see
  Jean Lindsay, <uA>u <uHistory>u <uof>u <uthe>u <uNorth>u <uWales>u <uSlate>u <
uIndustry>u, (David
 and Charles Inc, USA, 1974),  R. Merfyn Jones, 'Y Chwarelwyr: the
 Slate Quarrymen of North Wales', in Raphael Samuel (ed.), <uMiners,>u
 <uQuarrymen and Saltworkers>u (Routledge and Kegan Paul Ltd, London,
 1977); and R. Nerfyn Jones, <uStudies in Welsh History 4. The North>u
 <uWales Quarrymen 1874-1922>u, (University of Wales Press, 1981).
  2. R. Merfyn Jones, <uThe North Wales Quarrymen>u, p.72; 'Y
  Chwarelwyr',  p.101.
  3. Jean Lindsay, <uSlate Industry>u, p.298.
  4. J. R. Glover <uet al>u., 'Effects of exposure to slate dust in
  North Wales', <uBritish Journal of Industrial Medicine>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.), <uSymposium of Tuberculosis>u,  (Cassell & Co. Ltd,
  London, 1957), pp.645-84. Walter Pagel <uet al>u,  <uPulmonary>u
  <uTuberculosis: Bacteriology, Pathology, Diagnosis, Management,>u
  <uEpidemiology, and Prevention>u, 4th ed. (0xford University Press,
  1964), p.66.
  6. <uReports on Public Health and Medical Subjects No. 38A, Report>u
  <uof an Investigation into the Alleged High Mortality Rate from>u
  <uTuberculosis of the Respiratory System among Slate Quarrymen and>u
  <uSlate Workers in the Gwyrfai District>u, T. W. Wade, (Welsh Board of
  Health, London, HMSO, 1927) .
  7. <uReport of an Inquiry into the Occurrence of Disease of the>u
  <uLungs from Dust Inhalation in the Slate Industry in the Gwyrfai>u
  <uDistrict>u, Drs C. H. Sutherland and S. Bryson, (Mines Department,
  London, HMS0, 1930).
  8. <uReport of an Investigation into the Causes of the Continued>u
  <uHigh Death Rate from Tuberculosis in Certain Parts of North>u
  <uWales>u, Dr H. D. Chalke, (King Edward VII Welsh National Memorial
  Association, Cardiff, 1933).
  9. <uMinistry of Health, Report of the Committee of Inquiry into>u
  <uthe Anti-Tuberculosis Service in Wales and Monmouthshire (Clement>u
  <uDavies Report)>u, (London, HMSO, 1939) .
  10. Richard Titmuss, <uPoverty and Population, a Factual Study of>u
  <uContemporary Social Waste>u, (MacMillan & Co. Ltd, London, 1938),
  pp.169, 170.
  11.  Sir George Newman, <uOn the State of Public Health, Annual>u
  <uReport of Chief Medical Officer to the Ministry of Health for>u
  <u1921>u, (London, HMSO, 1922), p.62.
  12. see Malcolm Colledge,
  13. F.C.S. Bradbury, <uThe Causes of Tuberculosis>u, (National
  Association for the Prevention of Tuberculosis (N.A.P.T), 1933).
  14. <uClement Davies Report>u, P.258.
  15. <uWade Report>u, p. 6; <uChalke Report>u, p.20.
  16. <uClement Davies Report>u, p.259; <uChalke Report>u, p.68.
  17. <uClement Davies Report>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, <uPulmonary Tuberculosis: a Journey down the>u
  <uCenturies>u, (Bailliere Tindall book published by Cassel Ltd,
1978), p.73.
19.  <uChief Medical Officer of Health And Report for 1919>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.), <uWales and Medicine>u,  (British Society for the
History  of Medicine,  Wales,  1975),  pp.30-41.
21. PR0 MH75/26.
22. <uWestern Mail and South Wales News>u, 30 Jan.  1937.
23. PRO MH75/26.
24. R. Merfyn Jones, <uThe North Wales Quarrymen>u, pp.34-41.
25. <uParliamentary Debates, House of Commons>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 <uet al>u.,  ' Slate Dust in North Wales',  p. 152.
27. Wade Report, p.29.
28. Alice Stewart,  'Tuberculosis in Industry',  p.682.
29. <uWestern Mail>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, <uLiverpool Post>u, 5 July  1927.
32. Wade Report, unrevised, Appendix 3.
33. <uThe Slate Trade Gazette>u, Aug. 1927. Also reported in <uThe>u
<uCambrian News and Welsh Farmers Gazette>u, 26 Aug. 1927. Road dust
would, however, have included slate dust in the area.
34. <uThe Slate Trade Gazette>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, <uThe Cambrian News>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. <uChalke Report>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, <uTransactions of 24>u
<uN.A.P.T. Conferences>u, (1938), P.71.
43. PRO MH55/1211,  Dr Lloyd Owen, evidence before 1937-39
Inquiry.
44. J. Roberts, Llanberis, <uLiverpool Post and Mercury>u, 5 Aug.
1933.
45.  PRO MH55/1222,  Evidence of Dr J. W. Morris before Inquiry,
(also reported in <uCambrian News>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, <uBritish>u
<uJournal of Tuberculosis>u,  vol. 33,  (1939),  pp.219,  220.
48. T.W. Davies,  'Silicosis in Slate Quarry Miners', <uTubercle>u,
vol.20 (1939), 543-5.
49. <uThe Welsh Slate Industry - Report by Committee appointed by>u
<uMinistry of Works>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. <uWade Report>u, p.29.
51. <uThe Times>u, 19 June 1933.
52. PRO MH96/1056, <uReport of the Medical Committee of Memorial>u
<uAssociation>u, 10 Dec. 1931, (Memo. by Director of Research on the
incidence of Tuberculosis in Wales,  pp. 317, 318).  Emrys G.
Bowen, <uJournal of the Royal Anthropological Institute of Great>u
<uBritain and Ireland>u, vol. 63  (1928),  pp.363-399.
53. Montgomeryshire Insurance Committee meeting, <uCounty Times>u, 24
0ct.  1931.
54. PR0 MH75/15; MH96/1056. J.E. Tomley, <uThe Manchester Guardian>u,
15 July 1933.
55.  Dr A. C.  Watkin, <u19 Annual Conference N.A.P.T.>u (1933),  p. 145.
Kenneth Morgan points out that language differences in Wales
implied much deeper cultural divisions, <uRebirth of a Nation>u,
<uWales, 1880-1980>u, (0UP, 1982), p.88.
56. <uLiverpool Post and Mercury>u, 5 Aug. 1933.
57. R. C. Hutchinson, 'Tuberculosis in a Welsh Country Community',
<uTubercle>u, vol. 2 (May 1921), pp.345-9.
58. <uChalke Report>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. <uCaernarvonshire Joint Sanitary Authority, 29>u
<uAnnual Report for 1936>u (1937), G. Lewis Travis and E. Lloyd,
Recommendations,  no. 13.
62. <uChalke Report>u, p.32.
63. <u24 N.A.P.T. Conference>u (1938), p.70.
64. PRO MH75/15. <uThe Times>u, 19 June 1933.
65. <uCambrian News>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. <uTubercle>u, vol.17 (March 1935),  p.267.
68.  See for example, <uTubercle>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', <uOn the>u
<uState of Public Health, Report of the Chief Medical Officer of>u
<uthe Ministry of Health for 1919>u,  (London, HMSO, 1920), Appendix
5, p. 337
70. Wade Report, unrevised, Appendix 3.
71. Ibid.
72. <uChalke Report>u, p. 18.
73. <uWestern Mail>u, 19 July 1933.
74. Ibid.
75. <uLiverpool Post and Mercury>u,  13 Nov.  1934.
76. Ibid.
77. PRO MH55/1243.
78. Ibid.
79. Ibid.
80.  <uClement Davies Report>u, p. 36.
81.  <uChalke Report>u,  p. 44.
82. R. Merfyn Jones' <uThe North Wales QUarrymen>u, p. 31.
83. <uChalke Report>u, pp. 17, 18, 43. <uThe Times>u, 19 June 1933.
84. PR0 MH55/1208, Evidence before 1937-39 Inquiry.
85. Ibid. See also V. Emrys Jones, <u24 N.A.P.T. Conference>u,
(1938), p.71; and Dr Lloyd Owen, <uCaernarvon and Denbigh Herald>u, 4
Dec.  1931.
86. <u13 N.A.P.T. Conference>u, (1927),  pp.16,  36.
87. Synopsis of films, <uAnnual Report N.A.P.T. Council for 1924>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.  <uThe Cambrian News>u, 2 May 1924; <uClement Davies Report>u, p. 93;
F.R.G. Heaf, <uSymposium of Tuberculosis>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. <uRees Report on Welsh Slate Industry>u,  p.15; Jean Lindsay,
<uNorth Wales Slate Industry>u,  p. 298.
96. Wade Report, unrevised, Appendix 3.
97.  P. Wright and A. Treacher (ed.), <uThe Problem of Medical>u
<uKnowledge, Examining the Social Construction of Medicine>u,
(Edinburgh University Press, 1982), Introduction by Wright and
Treacher, p.4.
98. <uChalke Report>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, '<uBritish>u
<uHeart Journal>u 1949 (11) 370-389

(2) M. Oliver, 'Does control for risk factors prevent coronary heart
disease' <uBMJ>u (285) 1065-1066


13
(3) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedica
l>u
<uOfficer>u <u'On>u <uthe>u <uState>u <uof>u <uthe>u <uPublic>u <uHealth'>u <ufo
r>u <uthe>u <uyear>u <u1922>u
(HMSO 1923) p 15

(4) ibid, p 16

(5) ibid, p 16


(6) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedica
l>u <uOfficer>u
<u'On>u <uthe>u <uState>u <uof>u <uthe>u <uPublic>u <uHealth'>u <ufor>u <uthe>u
<uyear>u <u1925>u (HMSO 1926) ,
p 55

(7) <uThe>u <uRegistrar-General's>u <uStatistical>u <uReview>u <uof>u <uEngland>
u <uand>u <uWales>u
<ufor>u <uthe>u <uyear>u <u1930>u (HMSO 1932) p 85-86

(8) <uThe>u <uRegistrar-General's>u <uStatistical>u <uReview>u <uof>u <uEngland>
u <uand>u <uWales>u
<ufor>u <uthe>u <uyear>u <u1933>u (HMSO 1932) p 67-68

(9) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedica
l>u
<uOfficer>u <ufor>u <uthe>u <uyear>u <u1933>u (HMSO 1934) p17

(11) W.P.D. Logan, 'Mortality in England and Wales,' <uPopulation>u
<uStudies>u 1950 (4) 132-178

(12) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedic
al>u
<uOfficer>u <ufor>u <uthe>u <uyear>u <u1933>u (HMSO 1934) p 206, 252

(13) Charles Webster, 'Healthy or hungry 'thirties?' <uHistory>u
<uWorkshop>u <uJournal>u April 1982 (13) p 110-129

(14) Sources: Logan op. cit and <uRegistrar-General's>u <uStatistical>u
<uReviews>u for the years 1951, 1961, 1971

(15) Sir George Greenwood - <uThe>u <uLaw>u <uof>u <uDeath>u <uCertification>u
(Published on behalf of the Society for the Prevention of
Premature Burials, Oxford University Press, 1928)

(16) <uThe>u <uRegistrar-General's>u <uStatistical>u <uReview>u <ufor>u <uthe>u
<uyear>u <u1951>u
(HMSO 1954) p 218

(17) ibid p 218

(18) ibid p 218

(19) <uThe>u <uRegistrar-General's>u <uStatistical>u <uReview>u <ufor>u <uthe>u
<uYear>u <u1956>u
(HMSO 1958) p 188-191

(20) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedic
al>u
<uOfficer>u <ufor>u <uthe>u <uyear>u <u1962>u (HMSO 1963) p 25

(21) Ministry of Health - <uAnnual>u <uReport>u <uof>u <uthe>u <uChief>u <uMedic
al>u
<uOfficer>u <ufor>u <uthe>u <uyear>u <u1963>u (HMSO 1964) p 23


                      14
(22) M. Fulton et. al., 'Sudden death and myocardial
infarction,' <uCirculation>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,' <uLancet>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 - <uDiscovering>u <uSuicide:>u <uStudies>u <uin>u <uthe>u <uS
ocial>u
<uOrganisation>u <uof>u <uSudden>u <uDeath>u (Macmillan, London, 1978) p. 98

(29) joint Committee of the Royal Colleges of Physicians and
Pathologists, 'Medical Aspects of Death Certification,' <uJournal>u <uof>u <uthe
>u
<uRoyal>u <uCollege>u <uof>u <uPhysicians>u <uof>u <uLondon>u 1982 (16) 205-218

(30) H.M. Cameron and E. McGoogan, 'A prospective study of 1152
hospital autopsies. I: Inaccuracies in death certification, '<uJournal>u
<uof>u <uPathology>u 1982 (133) 273-283

(31) Wendy Farrant and Jill Russell - <u'Beating>u <uHeart>u <uDisease':>u A Cas
e
Study on the Production of Health Education Council Publications
(institute of Education Health Education Publications Project,
unpublished monograph 1983)