Medical Opinion and Sociopolitical Control in the Case of Occupational disease in the late 19th Century Germany

Medical Opinion and Sociopoli ical Con ol in he Case o Occupa ional Diseases in he la e Nine een h Cen u y DIETRICH MILLES (*) RESUMEN En es e abajo se iden i ican los iesgos pa a la ida y la salud de los abajado es indus iales en el con ex o del segu o obliga o io de acciden es es ablecido en Alemania a comienzos de siglo. En el con ex o del desa ollo indus ial y los cambios sociopolí icos apa eció el p oblema de de ini iesgos y p oblemas c óiiicos, en pa icula las in oxicaciones. La inclusión de las en e medades ocupacionales en el segu o de acciden es en a izó la dimensión biog á ica del padecimien o, pe o di icul 6 el desa ollo de la unción p e en- i a del Reglamen o de en e medades labo ales de 1'325. Occupa ional diseases in Ge many oday a e hose diseases o which compensa ion is g an ed in he same way as io acciden s, i hey a e caused by pa icula in luences o which ce ain g oups o people, h ough hei wo k, a e subjec ed o a g ea e deg ee han he es o he popula ion (1). Fecha de acep ación: 6 de mayo de 1992. (*) Sozialpoli isches A chi . Zen um ü Sozialpoli ik. Uni e si a B emen. Pa kallee 39. D 2800 B emen 1. Alemania. (1) The ollowing pape is an accoun o esea ch wo k cu en ly being ca ied ou in Subp ojec D1 .The cons uc ion o biog aphical isk in Occupa ional Disease P oceedings 1889-1929. as pa o S b 186 «S a us passages and condi ions o isk in he li e cou se a he Uni e si y o B emen. Foi- ansla ing and suppo 1 would like o hank icki May and Sabine Tengele . C T. MILLES, Die ich (ed.) (1992). Be iebsan e und p oduk ionsbaogene Gesundhei spoli ik in de Geschich e, B eme ha en, Wi scha s e lag; (1993). Gesundhei s isiken, Zndus iegesellschaj und soziale Siche ungen in de Geschich e, ~ eme ha en, Wi scha s e lag. DYNAMIS Ac a Hispanica ad Medicinae Scien ia umque His o iam Zllí~s andam. Vol. 13, 1993, pp. 139-153. ISSN: 021 1-9536 140 DIETRICH MILLES They a e de ined by expe s in line wi h he la es de elopmen s in indus- ial medicine and speci ied in lis s in he Occupa ional Disease O dinance (2). I is incon es able ha wo ke s a ec ed by such diseases and cioc o s ha e known abou hem and he su e ing and dis ess associa ed wi h hem since he la e 17 h cen u y (3). Howe e , acco ding o Ge man social insu ance (4) as i was es ablished in he ea ly 1880s, hese occupa ional diseases did no exis . Fo he pu poses o his insu ance he e exis ed ei he diseases which mani es ed hemsel es as o ganic de ec s and we e ea ed and assessed as such, o acciden s, which we e de ined as sudden e en s b ough abou by un o eseen ci cums ances. This dis inc ion was i s made in he 1870s and inco po a ed medical knowledge in o legal p oceedings, making ju idical and medical de ini ions in e dependen (5). By he end o he cen u y, howe e , isk, legal p oceedings ;and medical knowledge no longe ma ched (6). Doc o s had o o m an opinion on connec ions be ween causes and e ec s in he legal sense, he cons uc ion (2) C . MILLES, Die ich (1988). Occupa ional illnesses o be co npensa ed, o wo ke 's diseases o be e adica ed? Dynamis, 7-8, 275-305; (1993). Wha a e Occupa ional Diseases? Risk and he concep o isk in he his o y o indus ial medicine. In: COOTER, R.; LUCKIN, ]B. (eds.), Acciden s in His o y. Inju ies, a ali ies and social ela ions, ( o hcoming) . (3) C . URBE, Ka l-Heinz (1978). Die En wicklung de A bei smedizin in Deu schland on 1780 bis 1850 im Spiegel de zei genossischen medizinischen Li e a u , Diss, Leipzig; BUESS, Hein ich (1961). Die E o schung de Be u sk ankhei en bis zum Beginn cles indus iellen Zei al e s. In: BAADER, E. W. (ed.), Handbuch da gesam en A bei smedizin, Be lin, Bd. 2/1, pp. 15-36; WEINDLING, Paul (ed.) (1985). The social his o y o occupa ional medicine, London, C oom Held, 267 pp. (4) Fo an in e na ional co npa ision see HENNOCK, E. P. (1987). B i ish Social Re om and Gaman P eceden s. The Case o social Insu ance 1880-1914, Ox o: d, Cla endon P ess; RITTER, Ge ha d A. (1982). Sozial e siche ung in Deu schland und England. En s ehung und O undzüge im Ve gleich, München, Oldenbou g; MOMMSEN, Wol gang; MOCK, Wol gang (eds.) (1982). The eme gen e o he wel a e s a e in B i ain and Gmany 1850-1 950, London. (5) C . BARTA, H. (1983). Kausali a im Sozial ech . En s ehung und Eunk ion de sogenann en i'heo ie de wesen lichen Bedingung, 2 ols., München, Duncke & Hunibol . (6) C . MILLES, Die ich (1990). Indus ial Hygiene: A S a e Obliga ion? Indus ial Pa hology as a P oblem in Ge man Social Policy. ln: LEE, Robe W.; ROSENHAFT, E e (eds.), S a e and Social change in Gmany, London, Be g, pp. 161.-199; MILLES, Die ich (1990). 'Küns liche' und 'na ü liche' Risiken in de Geschich e de A bei smedizin. In: Ha nbu ge S i ung ü Sozialgeschich e des 20. Jah hunde s (ed.), A bei sschu z und Umwel geschich e, Koln, Volksbla Ve l., pp. 101-118, 192-194. The Case o Occupa ional Diseases 141 o which co esponded less and less wi h hei ield- o knowledge and inc easingly con lic ed wi h hei medical sclu ies (7). The cons uc ion o isk, which i owed o he pa icula ole o acciden insu ance in Ge many, is he cen al issue o his pape . Acciden insu ance ep esen ed he hea o he Ge man social cons i u ion, as i egula ed he new and se ious heal h p oblems and haza ds which mode n indus ial socie y imposed upon i sel (8). Acciden inslu ance, which was discussed in he Reichs ag be o e he es ablishmen o gene al s a u o y heal h insu ance in 1883, bu was only se led in 1884, elie e~d employe s' o liabili y, which had been he cause o massi e social con lic . Hence o h, i a sudden, empo ally de e minable e en in he cou se o insu ed employmen led o an asce ainable impai men o heal h, hen he pe son conce ned o hei su i ing dependen s could claim an acciden pension p opo iona e o he de e mined deg ee o incapaci a ion. This con i med ha indus ial en e p ises concealed ce ain una oidable heal h isks; i also assumed ha hese could be egula ed in e ms o he de ini ion o an acciden . This egula ion was in ended o he ype o heal h isks which we e cha ac e is ic o hea y indus y, s eam boile s and ansmission bel s as well as mani es social inequali ies (9). I was se up in he ea ly 1880s in he mids o a pa icula his o ical si ua ion which 1 shall only men ion wi h e e ence o - he g ow h o he i on-p oducing and p ocessing indus y accompanied by an changing concep ion wi hin he ie:ld o enginee ing o isk and p oduc ion planning; - o he de elopmen o na u al sciences and. he co esponding legi ima ion o poli ical in e en ion. (7) C', BEHRENS, J.; MILLES, D.; MULLER, R. (1990). Zu Medikalisie ung sozialpoli ische Kon lik e. Gu ach e medizin zwischen Sozials aa iund Indi iduum. In: DRESSEL, W. e . al. (eds.), Lebenslau ; A bei smadz und Sozia&oli ik, Nii nbe g, Mi3 B A, pp. 151-173. (8) C . EWALD, F ancois (1986). I>@ a p o idence, Pa is, B. G asse ; BECK, Ul ich (1986). Risikogesellscha . Au dem Weg in eine ande e Mode ne, F ank u /M., Suh kamp. (9) C . BARTRIP, Pe e (1987). Wo kmenS Comj,ensa ion in Twen ie h Cen u y B i ain: Law, Hzs o~y and Social Policy, B ook ield, Ve non , A ebu y; in gene al FREVERT, U e (1984). K ankha' als poli isches P oblem, 1770-1880. Soziale Un e schich en in P euJen zwischen medizinische Polizei und s aa liche Sozia ' e siche ung, Go ingen, Vandenhoeck & Rup ech . This pa icula his o ical si ua ion wds legally gene alised wi hin he social insu ance sys em. Towa ds he end o he cen u y, he media ion be weeni ins i u ional assump ions o no mali y and indi idual concep s o li e and en i lemen o s a e bene i was p eca ious: he his o ical si ua ion was cha ac e ized, among o he hings, by - a p o ound change in wo k p ocesses and wo k o ganisa ion as ypi ied by Taylo isa ion and he inc eased use o chemicals; - he so-called anega i e in eg a ion~ o he wo ke s mo emen s, especially ia he social insu ance sys em; - and he end o he Bisma ck e a and he a emp s a social in eg a ion in o de o make he Ge man na ional economy compe i i e. This was e lec ed in discussions among a ec ed wo ke s, Social Democ a s, social e o me s, employe s and hei associa ions, ep esen a i es o he ade associa ions, ac o y doc o s, hygienis s and o icials o e indus ial, occupa ional o wo ke s' diseases. One conside able p oblem was he g ow h o complex and la en haza ds and, hence, ch onic diseases, which was abo e al1 discussed in ela ion o in oxica ion (10). This g ow h con lic ed wi h indi idual expec a ions and wi h insu e s' assump ions. Now and again he ques ion o a undamen al e o m o social secu i y was aised, howe e i lacked poli ical suppo because a he ime he social secu i y sys em con ibu ed a g ea deal owa ds sociopoli ical s abili y and i was no possible o ind accep able sociopoli ical ins i u ions and ac o s o implemen a - eaching e o m (11). The p oblem was he e o e how o econsé uc ce aini diseases o econcile he medical and legal de ini ion o occupa ional diseases wi hin he amewo k o social secu i y as i al eady exis ed. Discussions ocussed (10) C . ROTHE, Ch is iaii (1987). E k nnkungen on Chemiea beile n z nd die En uicklung de Be u sk ankhei en e o dnung on 1925, F ank u , [Diss. med.]; HIEN, Wol gaiig (1988). Che niea bei , Anilink ebs uiid Disposi ionsmy hos am Beispiel de BASF Ludwigsha en. 1999. Zei s hnj ii Sozialgeschich e, 3, 31-59. (1 1) C/ . BALDWIN, Pe e M. (1990). The Poli ics o/ Social Solidan(y. Class Bases o Eu opean Wel a e S a e, Ca nb idge, Camb idge C'ni . P ess; HENTSCHEL, Volke (1983). Geschich e de deu schen Sozialpoli ik (1 880-1 980). Soziak Sicl emng zcnd kollek i es A bei s ech , F ank u /M., Suh kamp. The Case o Occupa ional Diseases 143 on he ex ension o acciden insu ance o include disease p ocesses, and his was inally ealised in he Occupa ional Disease O dinance o 1925 (12). Due o i s paci ying e ec (13), he social insu ance sys em was s ill no s anda dized o eo ganized du ing discussions o e he Impe ial Insu ance O dinance in 1911. Lea ing aside he p oi ec i e measu es ollowing he implemen a ion o he Indus ial Code, he ii e en ia ion wi hin he social insu ance sys em can be illus a ed by he ollowing examples. The p oblem cen ed a ound long- known and new o is o chemical in oxica ion. Long- ecognised o ms o in oxica ion we e o ins ance hose caused by phospho us, lead and me cu y. The exac connec ions a e made clea by he ollowing example o phospho ous poisoning (14). The disco e y ha phospho us can be speci ically igni ed when mixed wi h non- lammable subs ances goes back o he ea ly 19 h cen u y. A i s whi e phospho us was used exclusi ely o manu ac u e ma ches in home indus y and in ac o ies. An awa eness o he heal h haza ds in ol ed g ew up almos immedia ely. As ea ly as 1843, P o . Die z o Nu embe g poin ed ou he inju ies phospho us caused o heal li and in 1845 P o . Lo inse o Vienna b ough ou a publica ion on bone diseases b ough on by he e ec o phospho ous apou s which he nained phosphonec osis. In 1847, chemis s in Bib a and he clinician Geis idesc ibed e he diseases o he wo ke s in phospho ous ma ch ac o ies, especially he condi ion o he jaw bones caused by phospho ous apou sn (Ei-langen). In he same yea he i s p o ec i e egula ions we e issued (15). In he la e 1870s public a en ion was oused by he condi ions and diseases exis ing in he ma ch ac o ies a Lauenbu g, whe e he e we e no less han ou la ge ac o ies p ocessing whi ~e phospho us. On in es iga ion he ac o y inspec o disco e ed ha wo ke s o en con ac ed phosphonec osis (12) C T. HOHMANN, Joachim S. (1984). Be u sk ankhli a in de Un all e siche ung. Vo geschich e und En s ehung de E s en Bmc sk ankhei en e o dnung om 12. Mai 1925, Koln, Pahl Rugens ein. (13) C . RODEL, U. e al. (1978). Sozialpoli ik als soziale Kon olle, F ank u /M., Suh kamp; SACHSSE, Ch.; TENNSTEDT, F. (eds.) (1986). Soziale Siche ha' und soziale Disziplinie ung. Bei age zu eine his o ischen Theon'e de Sozialpoli ik, F ank u /M., Suh kamp. (14) C . TELEKY, Ludwig (1955). Gewe bliche e p9ungen, Be lin; HAMILTON, Alice (1925). Indus ial Poisons in he Uni ed S a es, New Yo k. (15) C . DEHN, Paul (1882). A bei e schu zmaJ egei'n gegen Un all und K ankhei sgejah en, Be lin; BRAUN;Adol (1890). Die A bei e schu zgese ze de eu opaischen S aa en, Tübingen. 144 DIETRICH MILLES and had bad ee h and in lamed jaw bones. His epo exp essed in o icial e ms wha people in he a ea commonly and clea ly el o be a heal h haza d. On 27.6.1879 he Reichs ag eques ed he Chancello « o gi e o de s o he p elimina y s eps o be aken o p ohibi he manu ac u e o ma ches wi h whi e phospho usn. The Impe ial O ice o he In e io deal wi h he ma e u he and, as was usual in such cases, asked he ede al go e nmen s o hei commen s. The as majo i y o go e nmen s held he opinion ha a p ohibi ion awas no necessa y and, in conside a ion o he na ional economy, ques ionable~. Ins ead, egula ions should be issued on he p oduc ion o ma ches. Fo his pu pose he S a e Secipe a y o he In e io appoin ed a commission (16). Public discussion con inued, howe e , and poli ical specula ions on ela ions be ween he Impe ial Chancello and indus ialis s p omp ed o icial enqui ies. In eply o one enqui y, he Minis y o Comme ce epo ed in 1881 ha he ques ion «had been deba ed ... oi- yea s». The subjec o deba e had been he in lammabili y o Ge m'an ma ches especially in ela ion o Swedish ma ches and how g ea he h ea o phosphonec osis was o wo ke s. Apa om an accoun o o icial p ocedu es he ele an p inciples o he ma e we e educed o passages in he indus ial doc o 's annual epo . The e was no knowledge o public disquie and lqe au ho i ies had only applied o a p ohibi ion because o he inc ease in i es and no because o phosphonec osis. In 1893 an o dinance was issued which s ipula ed ha he endange ed wo ke s should be kep unde con inuous medical obse a ion and examined once e e y h ee mon hs. This ied in wi h he selec i e p ac ice o indus- ial hygiene which is implied by he ca chph ase ~ oca iona.1 choice and physical ap i uden. The en husiasm o social policy which g ew in he mid-1890s a e he down all o Bisma ck coincided wi h inc eased p essu e b ough on by a ious denuncia ions o he so-called ade il's ki chens» (Gi küchen) in he Reichs ag and a union mee ings, and o e ed an oppo uni y o he ma e o become poli icised (1 '7). (16) File in: ZSTA Po sdam RK 374, B1. 167. (17) C . SSCHNEIDER, Hein ich (1911). Ge ah en de A ba in de chenzischen Indus ie, Hanno e ; WURM, Emanuel (1905). Die gewe blichen Ve gi ungen. Die Neue Zei , 23, pp. 24 . The Case o Occupa ional Diseases 145 A ma ch ac o y wo ke named G ünig ' om P ungs ad , o example, handed in a pe i ion o he Reichs ag anh demanded ~ ha a ious diseases occu ing in he ma chmaking indus y, such as phosphonec osis, be included in he p o isions o acciden insu ancen. The pe i ion commi ee also acknowledged his demand o be equallyjus i ieci o o he o ms o in oxica ion, as hey eally we e a o m o indus ial acciden . A ecommenda ion o his e ec passed on o he Impe ial Chancello had no ini ial success, howe e (18). A las on 10.5.1903 he use o yellow phospho us was p ohibi ed, wi h e ec om 1907. Indus ial hygienis s had d awn a en ion o he heal h haza ds; bu a he same ime i became clea how li le oom o he conside a ions o indus ial hygiene he e w,as in he ield o social policy. In he mid-1920s Ludwig Teleky, who con ibu ed g ea ly o he en ichmen and poli icisa ion o he ield o indus ial hygiene, discussed wo di icul aspec s o in e na ional e o s o p e en wo k- ela ed phosphonec osis: i s ly he made i clea ha e en he p ohibi ion which had inally been dec eed was no aimed a he p oduc ion bu only a he use o he haza dous subs ance in ce ain ci cums ances. Secondly he poin ed ou ha he minimalisa ion o haza ds was a mo e o en pu sued o he p o ec ion o he consume ( oday we would add en i onmen al p o ec ion) han o he p o ec ion o he wo ke . Telelzy accoun ed o his wi h he ac ha al1 measu es aimed a p oduc ion would logically lead o a p ohibi ion o he p oduc ion o he use o he subs ance. Howe e , acco ding o Teleky, such demands could only be made i , on he one hand, he e was a echnological and economic subs i u e o he subs ance, and i on he o he hand he disad an ages o using he subs i u e we e smalle han he ex en o inju y a oided by i s use (19). Bo h conside a ions we e ealis ic and ~p ac icaln, bu a he same ime hey signi ied he annulmen o heal h p lo ec ion in indus y, o why should indus ialis s look o possible subs i u es and who was o calcula e when a subs i u e was po en ially mo e eco iomical? (18) Ci . HOHMANN (1984), op. ci . (n. 12), pp. 42 . (19) TELEKY, Ludwig (1926). Beg i , Diagnose, ech liche S ellung de Be u sk ankhei en. Ve hü ung gewe bliche Gesundhei sscha iigungen. Zn: GOTTSTEIN, A.; SCHLOSSMANN, A.; TELEKY, L. (eds.), E andbuch de sozialen Hygiene und Gesundhei s ü so ge, Be lin, J. Sp inge , ol. 2, pp. 41 . 146 DIETRICH MILLES The b anch o Ge man social secu i y in which wo ke s' heal h p o ec ion (20) a e de i ed om he Indus ial Code (especially pa ag aphs 107 and 120) had li le sociopoli ical schpe e e since he p inciple was adop ed in he 1870s no o ex end s a e con ol bu o ely on he sel - egula ion o he ade associa ions, which we e o ganised along he same lines as guilds. Fo his eason e en hose doc o s commi ed o ul illing hei s a e unc ions, as was he case wi h Ludwig Teleky, i s egional indus ial doc o in P ussia, placed hei hopes in ge ing he p oblem ecognised and deal wi h by way o insu ance. An endea ou was made o add ess he esponsibili y o employe s o a leas apply inancial p essu e ia ade associa es (i.e. employe s o pa icula ades o ganised wi hin ade associa ions) by es ablishing he de ini ion o wo k- ela ed diseases as acciden s. Bu as long as phosphonec osis was de ined as a disease, he e we e nei he he knowledge wi hin he ield o indus ial hygiene no he inancial p essu e o coe ce employe s in o using a subs i u e. This las poin can be illus a ed by one conc e e ins anc:e conce ning an appeal decision made by he Sena e a he Impe ial Insu ance O ice on .2.5.1887 (21). A wo ke a a ma ch ac o y sued he ade associa ion o he chemical indus y o no mee ing he claim o compensa ion. The wo ke had phosphonec osis and had had o unde go « he su gical emo al o he igh hal o he lowe jaw~. In acco dance wi h he medical epo , he Sena e iewed ph~osphonec osis as he ac i ical poin o a ch onic diseasep. Acco ding o indus ial hygienis s i was an ~es ablished ac n ha «no al1 wo ke s who a e exposed o phospho ous apou s o an equal deg een con ac ed phosphonec osis; u he , «i one qui s one's wo k in ime he sy np oms o ch onic phospho ous poisoning which a e al eady p esen disappea and nec osis does no occu n. Mos impo an was hei iew ha «i is no possible o de e mine a pa icula momen when he inhala ion o phospho ous apou s cause he ou b eak o nec osis; a he , nec osis is he esul o a long pe iod o exposu e o he apou s». Thus he Sena e uled ha phosphonec osis, like (20) C . PPENSKY, Angelika (1987). Schu z de A bei m o C;e ah en jü Leben und Gesundhei , B eme ha en, Wi scha s e lag. (21) Am liche Nach ich en des Reichs e sichemngsam es (AN) 1888, p. 147. The Case o Occupa ional Diseases 147 me cu ial o lead poisoning, was an «indus ial diseasen and, in con as o condi ions such as « he des uc ion o he lung issue o a wo ke due o he inhala ion o escaping chlo ic gases, o blood poisoning as a esul o phospho us en e ing a wounds, could no be ega ded as an acciden . The appeal o he wo ke , who had been unable o wo k o a long pe iod and was now de o med, was decla ed ano legallj ounded~. The employe and his ade associa es we e clea ed. Ne e heless, in 1891, p omp ed by an inc ease in simila cases and by public p essu e, pa icula ly unde he in luence o Social Democ a s, he Impe ial Insu ance O ice unde Bodicke compiled a numbe o ema ks made by he Sup eme Cou and asked: «Can so-called indus ial diseases be classed as indus ial acciden s as de ined in he Acciden Insu ance Ac o 6 h July 1884?». This b ings o ligh he in insic sociopoli ical elemen o acciden insu ance: he ede ini ion o social p oblems as p i a e mis o unes ela ed o waged employmen . On 6.7.1888 he Thi d Ci il Sena e o he Impe ial Insu ance Cou uled ha he e m «acciden » be de ined in a na ow sense as a « empo ally de e minable occu encen. They a gued h he occupa ional disease in ques ion, howe e , ecould no be a ibu ed o he g adual conse o he e ec s o a pa icula occu ence, bu was an in oxica ion which had de eloped o e a numbe o yea s as a esul o cons an ly handling whi e lead, i.e. i was a ch onic disease caused by con inua1 exposu e ( o whi e lead). This is di ec ly connec ed wi h he occupa ion o he Plain i and mus be ega ded as an occupa ional disease, he na u e o which is unal e able e en i , as he Plain i asse s, he De endan ailed o mee he egula ions and make he necessa y p o isions o a e he dange . Diseases a ising g adually ou o he e ec s o indus ial p oduc ion a e howe e no acciden s, bu he common and o eseeable d awbacks o an inhe en ly unheal hy indus y which mus be aken in o accoun by e e yone pa icipa ing in ha indus y. The Acciden Insu ance Ac does no p o ide o insu ance agains such diseases o in alidi y esul ing om hem. (22). Wi h ha , occupa ional diseases e11 h ough al1 he meshes o he social secu i y ne . No only did acciden insu ance p o ide no p o ec ion, bu nei he did liabili y acco ding o Ci il Code, which sough o combine (22) En scheidungen des Reichsge ich s in Ci ilsachen, BEI. 21, 1889, pp. 77 ; AN, 1891, p. 254.