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Occupational & Environmental Medicine
“A superbly researched and scholarly book that traces the history of the author’s selection of relatively well-known occupational hazards.”
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A few years ago, I was asked to provide a medical consultation for a four-month-old
boy who was admitted to the hospital because of possible appendicitis.
He was of an unusually young age for such a problem, but the
precipitant of the problem was more unusual still. A few weeks before, the
parents of the boy had noticed symptoms of colic in the infant and treated
him with the remedy that had been used in their home village in rural
Mexico for generations: they gave him some quicksilver to drink.
One might wonder how this village had gone on for very many generations
with this kind of folk wisdom, but, in fact, quicksilver (another name
for pure elemental mercury) isn't taken up through the stomach or intestines
very quickly. By other routes mercury is indeed quite hazardous; for
example, if inhaled, it rapidly enters the body through the lungs, and in
forms such as salts and their by-products it is well absorbed through the
gut. But in most cases, when quicksilver is taken by mouth it passes right
through the system. It may not cure colic, but it doesn't do toomuch
Mercury, however, is a curious substance. Because of its properties, it
may not pass. It is a fluid, but it is also very heavy, much more so than
water. For this reason, liquid mercury tends to settle to the lowest spot it
can. The appendix, hanging as a little tail off the intestines, is just such a
low spot. In the case of this child, the appendix filled up like a thermometer.
By X-ray, the dense mercury in his abdomen lit up like a metallic
worm. He was suffering from a mercury-impacted appendix that, in the
end, required surgical removal.
Toxic substances have become so much an everyday fact of modern life
as to verge on being perceived as a cliché of risk rather than as a true and
substantive threat. We may find it incredible that anyone could use quicksilver
as a folk remedy. Then again, many of my peers, members of a generation
who were children or adolescents in the 1950s and 1960s, can report
at least one experience of playing with mercury in the schoolyard or,
better yet, mixing up tiny puddles of it in their own basements.
Times do change. To an important extent, so too do the toxins to which
we are exposed. These changes involve more than simply evolving perceptions
of what constitutes an unacceptable risk. To keep up with an expanding
inventory of hazards requires tracking unusual if not arcane information
sources. On my preferred reading list is a twelve-page newsletter
published every week by the federal Centers for Disease Control in Atlanta.
Its upbeat name is the Morbidity and Mortality Weekly Report. The
cognoscenti refer to it simply as the MMWR.
In the pages of the MMWR, for example, one can learn of such cases as
that of a child in a Michigan suburb who was struck with a bizarre illness.
His hands turned pink and began to scale, he began to drool, and his mood
became irascible and difficult to manage. An unusual infection was considered
as one possible explanation, but this was excluded by laboratory
testing. No hereditary condition fit his bizarre constellation of abnormalities.
But the child's syndrome does have a name. The illness is called pink's
disease. It was, at one time, a well-known entity.
This syndrome, including both the odd skin changes and ominous nervous
system findings, is exactly how mercury poisoning is manifest in a
child afflicted with chronic poisoning. This child's parents had not given
him mercury to drink as a home remedy, nor had he been experimenting
with quicksilver in the family room. An exhaustive battery of questions revealed
little. When asked of any recent changes at home, the parents could
report only that the interior of the house had recently been repainted.
There was nothing extraordinary in that: a standard commercial indoor
latex paint had been applied. Yet when the child was tested, he had extremely
high mercury levels. The rest of the family was tested as well. They,
too, were poisoned, albeit less severely.
What, then, was the source of their toxic exposure? The answer lay in the
seemingly innocuous house paint. As it turns out, it contained excessive
amounts of an approved chemical additive intended to prevent mildew.
That additive is called phenyl mercuric acetate, a form of mercury not previously
associated with human illness. Nonetheless, enough mercury had
vaporized from the paint to cause harm. Trapped within the indoor environment,
it turned the suburban house into an ideal exposure chamber,
leading to mercury poisoning in the entire family.
The links between the first child, with mercury in his appendix, and the
second, suffering the effects of mercury inhalation, are stronger than they
might appear at first. The link is not simply that the same toxin was involved
in each case. The more important tie is that a single, ancient hazard
is still present in our everyday environment, not only in an old and traditional
form but also in an entirely new combination. This is a scenario repeated
all too often in the last decade, the last fifty years, and stretching
back over a span of centuries.
REVISIONIST ENVIRONMENTAL HISTORY
The pages that follow will detail the stories of many of these recycled and
reinvented hazards. These stories call into question what we may take as a
given: that because our modern ecological concept of the "environment" is
relatively new, the toxic threats that drive our understanding of this construct
are also of recent origin. The superficial timeline of environmental
history, it is true, supports this mistaken view. When I first began my training
in public health, focusing on occupational safety and health, the United
States was preparing for its bicentennial. The Occupational Safety and
Health Administration and the Environmental Protection Agency were
both less than ten years old. Earth Day was an idea in its infancy. The pockmarked
geography of our poisonous landscape had not yet erected the familiar
signposts of Love Canal or Chernobyl, catastrophes that were to follow
in the later 1970s and 1980s. The environmental map, as we know it
today, was then largely terra incognito.
We've come a long way since then. Ironically it's just far enough to see
the emergence of what can best be labeled a revisionist history of both the
movement for environmental protection and even the environment itself.
Central to this revisionism is an inclination to debunk and discard almost
any concern that may be raised over the risks of toxic substances. Whether
a hazard is identified on the basis of laboratory studies, is linked to an outbreak
of human illness, or is detected as a more subtle ecological threat on
a global scale, the revisionist response invariably minimizes the risk.
Revisionist environmental theory justifies attacks on key pieces of environmental
legislation. For example, in 2000 the American Enterprise Institute-
Brookings Joint Center on Regulatory Studies revisited the question
of lead's adverse effects on childhood intelligence. The report issued
did not dispute that the metal was toxic but found that the economic benefit
to parents was only eleven hundred to nineteen hundred dollars per IQ
point gained through lead abatement. The spare-the-lead-and-spoil-the-child
conclusion the report reached reads, "This analysis suggests lead standards
will redistribute resources from parents to their children, because the
benefits to parents are less than the costs of the standards. The Environmental
Protection Agency and the Department of Housing and Urban Development
should reconsider their lead standards."
New versions of environmental history instruct us that our fetish over
toxins is likely to be seen by future generations for the absurdity that it
surely must be. The environment can take care of itself, we are falsely reassured,
just as it has always done. Woody Allen humorously mined this
vein in his film Sleeper a number of years ago, portraying a character waking
up in the not-too-distant future only to discover a world in which cigarettes
and high cholesterol diets have been found to be health promoting.
Allen's film was healthy satire, but the revisionists would have us take it as
a documentary. They promote as established fact the dangerous misconception
that environmental concerns are purely modern creatures born of
our narcissistic age.
Perhaps this distorted view merely reflects a general shortsightedness we
all share to one extent or another. William Faulkner observed that the old
do not perceive the past to stretch back linearly. Rather, they look back
through a very narrow corridor of sequentially ordered recent history,
which then opens out onto a wider expanse of time, as if a large meadow
where more distant and less distant events, like cattle, graze comfortably
together. The timeline of environmentalism can be similarly perceived,
even by those closest to the movement itself. About as far away as anyone
can make out in this landscape stands the distant figure of Rachel Carson,
heroically holding aloft a copy of Silent Spring. In the cosmology of environmentalism,
one cannot even extrapolate beyond this point: we arbitrarily
fix the date of the ecological big bang as the year 1962.
Thus, for all intents and purposes, Silent Spring becomes a holy text, a
Veda of the environmental movement's own creation myth. DDT serves
as totemic a role in this mythology as Jackie's pillbox hat serves for the
myth of a Kennedy Camelot (from precisely the same time period). Back
beyond 1960, in environmental time, there is only an expanse of apocryphal
prehistory in which vague rumor or impressionistic allusion links
scattered images or anecdotes of contamination with possible real historical
events. A connection is sometimes made between the expression "mad
as a hatter" and mercury poisoning, which occurs in the hat trade from use
of the toxin to make felt from rabbit fur and can result in mental derangement.
The theory that widespread lead poisoning may have contributed
to the decline of the Roman Empire is recycled with a certain frequency.
Otherwise, all seems unformed and void, even to most environmentalists
In fact, the true environmental record is far from a blank slate. There is a
rich and well-documented history of injury and illness, much of it concentrated
in the workplace or in neighborhoods contaminated from spillage
just beyond the factory door. This history has a clear and important message
to transmit. It shows us how time and again innovative processes have
been introduced into large factories or small workshops, novel products
have entered the marketplace, and new contaminants have been released
into the environment. Each time these have occurred, episodes of disease,
disability, and death have ensued. This is not a new story beginning in
1960 or even in 1690. It is an old, sad tale that gets told over and over but
seems somehow to be forgotten after each new recitation. The revisionist
recounting of the anti-environmental time line intentionally undermines
it, characterizing the issues involved as little more than a modern fad that
will soon pass and be forgotten. The environmentalist sense of the movement's
history, cut off from much of its own past, often has the same net
We must reclaim our lost history so that, going forward, we can accurately
judge the steps we must take to address the public health and safety
threats before us today. These threats predictably arise as the unintended
by-products of the ways in which we make and use consumer goods and
produce and transport basic commodities and industrial materials alike.
This does not mean that health and safety risks are unavoidable. Rather,
past experience teaches that the amelioration of these problems will require
strategies geared to their complex social, economic, and technological
This chapter reexamines some of the deceptively simple but incorrect assumptions
that we have about what is, in fact, "new" in our environment,
whether at work, at home, or in the wider ecosystem. We can easily start
with a list of our hypermodern concerns that seem to be of recent origin:
pollution in the water and air; asbestos fibers in our workplaces and schools;
carpal tunnel syndrome from our keyboards; sick building syndrome from
our sealed-in International Style offices; and the vague toxicity of "burnout"
from the day-to-day stress of modern life.
Nothing is more prototypically modern than the specter of massive water
pollution from an oil tanker spill. Thus the Exxon Valdez sails on in the
public mind as a kind of latter-day, environmental Flying Dutchman. This
symbolism was epitomized by the tanker's Hollywood reappearance as a
postapocalyptic, floating palace of evil in the 1995 film Waterworld.
I had always assumed that much before 1970, and certainly before 1960,
people had little or no awareness of the possibility of significant ocean pollution
from any man-made source, particularly from petroleum transport.
Completely by accident, I came across a small pamphlet in a secondhand
bookstall that forced me to rethink this chronology. It was a copy of a
groundbreaking report submitted to the Council of the Royal Society in
Great Britain, one of the world's leading scientific institutions. Entitled
The Pollution of the Sea and Shore by Oil, its twenty-two pages lay out with
great foresight this emerging environmental threat. The report is dated
The author of the pamphlet, a university chemist named Neil K. Adam,
gathered his information from a wide variety of sources, including ninety-three
beaches in England, personally inspected over a single summer. Of
these beaches, he found that eleven were heavily polluted and twenty-one
were moderately so. Adam identified "wrecks of oil burning ships or oil
tankers ... holed so as to allow the oil to escape" as a major source of pollution.
He also described in great detail the effects of oil spills on bird life:
Birds are washed, or in some cases swim, ashore, with their feathers more or
less covered with the tarry residues from fuel oil; they are often alive when
they come ashore, but it is usually hopeless to try to save them. If there is
any quantity of oil on them, they cannot fly, and it is stated that they cannot
swim or dive either; they must die of starvation.... Cleaning oil off
birds is extremely difficult; solvents such as petrol remove the natural grease
so that water penetrates the feathers and the bird dies of cold.
To further document these effects, Adam reviewed the files of the Royal
Society for the Prevention of Cruelty to Animals in Britain. One inspector
of the society regularly sent reports for the same thirteen-mile stretch of
beach. In the twelve months ending 31 August 1936, the inspector had
counted over fourteen hundred oiled birds.
Despite its far-sighted environmental message, The Pollution of the Sea
and Shore by Oil remains an obscure document. I have never seen it cited,
and other than my own copy, I have been able to identify only two copies
held in major libraries. This should not be all that surprising. The report's
cover is clearly marked in a printed, underlined subtitle, For Private Circulation
Recognition of the environmental threat resulting from the chemical
contamination of freshwater rivers goes back considerably further than
awareness of the threat of ocean discharges. Indeed, freshwater pollution
was a stimulus for the formation of some of the earliest public action forerunners
of modern environmental groups. One of these was Britain's Fisheries
Preservation Association, whose 1868 pamphlet On the Pollution of the
Rivers of the Kingdom reads as if it could have been drafted by the Sierra
If our modern concerns over water pollution are not so very new after all,
then what about air pollution? Consider the following scenario: A toxic
cloud menacingly overshadows an entire community, even though scientists
have previously assured the public that such an event is highly unlikely
if not impossible. The federal government rapidly dispatches a public
health team to the site in Pennsylvania. The team of scientists try to come
to grips with the new mix of hazards they encounter but conclude that,
without long-term research, the effects of such exposures cannot be adequately
understood. This is not a description of Three Mile Island circa
1980. It involves a small factory town called Donora, near Pittsburgh. The
date is 1948. For four days in October of that year, a meteorological inversion
trapped deadly air pollutants over the town, making hundreds ill and
killing a score of the town's inhabitants.
Excerpted from How Everyday Products Make People Sick
by Paul David Blanc
Copyright © 2007 by The Regents of the University of California.
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
List of Abbreviations IX
Preface to the 2009 Edition XI
1 The Forgotten Histories of "Modern" Hazards 5
2 The Shadow of Smoke: How to Evade Regulation 28
3 Good Glue, Better Glue, Superglue 45
4 Under a Green Sea: The Rising Tide of Chlorine 92
5 Going Crazy at Work: Cycles of Carbon Disulfide Poisoning 132
6 Job Fever: Inhaling Dust and Fumes 172
7 Emerging Toxins 215