From silicosis to silica hazards: An experiment in medicine, history, and the social sciences.

This special issue of the American Journal of Industrial Medicine looks back to the International Conference on silicosis that took place in Johannesburg 85 years ago [International Labour Office, 1930]. Held in 1930, this scientific gathering marked a turning point in the medical and economic history of pneumoconiosis. Moreover, this Conference, ground breaking in its own right, also laid the foundation for the International Labour Organization international convention on silicosis that followed four years later in 1934 [International Labour Office, 1934]. This meeting of experts from all over the industrialized world was convened by a most surprising duo: the Transvaal Chamber of Mines on the one hand, and the International Labour Office (ILO) on the other. The experts’ charge was to define the nosology for and delineate the etiology of silicosis, but they were also called upon to determine the basis of financial compensation for the disease and to make recommendations for the best ways to “manage” silicotic workers who might be compromised by silicosis, yet still able to work. That the conference attracted representatives of virtually every industrialized nation, most traveling a great distance to South Africa just as the worldwide Depression had begun, also signaled the broad social and economic international importance of silicosis. At that time of the Conference, following on the use of automatic drills, the working of deeper pits, the large scale commercial introduction of silica abrasives, and the massive growth of an exposed workforce, silicosis was killing or disabling tens of thousands of miners and other workers worldwide. Indeed, by 1930 silicosis was well on its way to take its place as the most lethal and sustained epidemic of occupational disease in the 20th century. The proceedings of the International Conference on silicosis served as a forewarning of the danger at hand, but also a rule book dictating how that emerging epidemic should be managed. The official biomedical parameters of silicosis were codified in 1930 in Johannesburg, but these considerations were tempered by various socioeconomic forces. These included especially the monetary value of mining and other industries involving silica and the power relationships among governmental representatives, business owners, organized labor, and unrepresented laborers (in particular South African Black workers). The purely biomedical elements of silicosis, without directly acknowledging these sociopolitical aspects, were meticulously spelled out in a series of resolutions, each of them voted on by the delegates in attendance. The consequences of this pivotal conclave have reverberated down the decades: occupational medicine still deals with its legacy to this very day. One after-effect of the Conference grew out of its selfimposed restricted focus. The forum deliberately excluded from its frame of reference nearly any consideration of coal worker’s lung disease beyond what might be related to silica contamination of the coal mine workings. This compartmentalization had a lasting impact on how coal worker’s pneumoconiosis came to be conceptualized in different locales, contributing to half a century of clinical and compensation heterogeneity among France, the UK, Belgium, and the United States, as well as other countries. Additionally, the Conference focused largely on the fate of White miners employed in South African gold mines, shaping the experts’ assessment of the silica exposureContract grant sponsor: European Research Council (ERC); Contract grant number: ERC-2011-ADG_20110406; Contract grant sponsor: SSILICOSIS Project (Principal investigator: Paul-Andr e Rosental); Contract grant number: 295817; Contract grant sponsor: Alliance Program Grant 2013 (to Columbia University and Sciences Po/Principal investigators: Paul-Andr e Rosental & David Rosner); Contract grant sponsor: Sciences Po 2013 Scientific Advisory Board (The dusts of Givors / Principal investigator: Paul-Andr e Rosental); Contract grant sponsor: INED UR11P-111-0 Project (Principal investigators: Lionel Kesztenbaum & Paul-Andr e Rosental). [This contract grant sponsor statement has been updated after its original online publication.] Correspondence to: P.A. Rosental, Sciences Po, 27 rue Saint-Guillaume, F-75007 Paris. E-mail: [email protected]