View largeDownload slide Image: courtesy Royal College of Physicians, © Madame Yevonde/Mary Evans Picture Library View largeDownload slide Image: courtesy Royal College of Physicians, © Madame Yevonde/Mary Evans Picture Library Our four previous reviews of historic texts on industrial disease risks covered single editions that are no longer in print, except as historical facsimiles. By contrast, Diseases of Occupations is still going strong and is now in its 10th edition [1,2]. The first five editions were written by Donald Hunter himself between 1955 and 1975 and it is these that are the focus for this review. Hunter had been a major figure in occupational health investigations during the Second World War, just as Legge had been in the first. Hunter was, in contrast to Legge, a teaching hospital physician and head of the Medical Research Council (MRC) unit for research in industrial medicine . Thus, he saw occupational diseases from a scientific and clinical casework perspective rather than in terms of their overall national incidence and as measures of the effectiveness of regulation. Diseases of Occupations offers readers a detailed account of the history of work and its effects on health, in addition to providing an essential aid to practitioners, as the most comprehensive available source of current knowledge on occupational health risks and their prevention. Each of the first five editions was successively updated to reflect changes in knowledge about risks and developments in occupational health practice since the previous one. They start in the immediate post-war period, soon after the creation of the National Health Service, from which occupational health was excluded. They end with the reforms that culminated in the 1974 Health and Safety at Work etc. Act. As a historian, Hunter gathered together a vast amount of information about humanity and work and then described, largely in a positive way, how problems had been solved and the worst abuses ameliorated . The early editions reflect the socially progressive spirit of the post-war world, but this optimism is tempered in later ones by the ever increasing knowledge of the harmful effects of many of the substances and processes coming into use, for example his own investigations into the neurological effects of alkyl mercury seed dressing at a factory in East London. Later editions note how these clinical findings on a small group of seed dressers became worldwide significance when similar effects were noted in those eating fish from Minamata Bay in Japan, where a chemical plant was discharging alkyl mercury compounds into nearby fishing grounds. The first quarter of the book is essentially a description of the interactions between work and health from pre-historic times up to the mid-20th century. This includes extensive commentary on the changing status of workers, from slaves to guild members, to factory hands and on to the more secure conditions that existed for some in the established and often recently nationalized industries at the time he was writing. Here, he shows a political and social awareness of the context of occupational disease risks and their prevention similar to that demonstrated by Oliver in his book written 50 years earlier, but with an approach that is rooted in mid-century socialism rather than Edwardian liberalism. The remaining parts of the book retain a historical flavour, for example by separating out the ancient metals, lead, mercury, etc., from newer entrants to the workplace, such as manganese and chromium. Many sections on specific risks begin with a brief history of the agent and of the recognition of its potential for harm. The growth in knowledge and understanding of occupational diseases from the time that Legge’s book was published in 1934 to Hunter’s first edition is phenomenal. A greater range of materials and many new processes had come into industrial use, and far more resources were allocated to investigating their risks. Here, the imperatives of war production between 1939 and 1945 played an important part. During the First World War, there had been increases in a wide range of industrial diseases and also in accidents. No comparable increases were apparent in the Second World War. Resources were mobilized early, the creation of Hunter’s MRC unit being one example of this. The growth in the range of industrial materials and processes and in knowledge of their risks continued between 1955 and 1975 and each edition of Diseases of Occupations delivered this information to a ready audience. One feature of this period was a renewed internationalism in occupational health activities through bodies such as the International Labour Organisation and the International Commission on Occupational Health. The text is full of examples garnered by the author from such contacts and subsequently became very much an international work of reference. One of the reviewers (T.C.) can recall using copies of it in hospital libraries in the UK, Newfoundland and New Zealand, while contemplating a career in occupational health. The presence of Hunter as a long standing examiner for the membership examination of the London Royal College of Physicians and his known tendency to challenge candidates in their orals with exhibits such as rock drills with water channels for dust suppression must also have added to his readers! The book kept its original style and format as long as Hunter was the author—small (A5), substantial (900–1050 pages) and authoritative; the 1975 edition provides a snapshot of the concerns at that time. For instance, the fibrotic risks from asbestos were now joined by mesothelioma and by an excess risk of lung cancer. Pesticide risks were being defined and controlled, both for now banned agents such as di nitro ortho-cresol and for the still widely used organophosphates. In the case of the latter, Hunter engages in a polemic about the need for regulation with the self-explanatory but quaint title of ‘Apathy in the Mother of Parliaments herself’, noting the failure of a parliamentary committee to take action based on expert testimony from himself and other members of the MRC . The extension of ionizing radiation risks from the limited confines of medical X-rays and radium dial painters to the whole population through atomic weapons tests, the nuclear industry and the threat of nuclear war is covered at length but without, in this case, any social or political commentary . Some of Hunter’s perspectives on problems are surprising to later readers. Aluminium does not appear in the chapter on the newer metals, rather it appears among the inert dusts. This reflects Hunter’s own work on the health effects of machining aluminium alloy aircraft propellers in the Second World War. He had looked for risks but found none. Aluminium also features in a therapeutic context as trials were in progress in North America to see whether post-shift inhalation of aluminium powder reduced silicosis incidence in at-risk miners. To later readers, the chapter on occupational cancer risks in the 1975 edition has an antique feel. The manufacture and use of plastics had grown rapidly in the previous decades and this edition was published soon after the stark evidence of angiosarcoma of the liver in workers exposed to vinyl chloride, the monomer used to make PVC, led to international concerns about its carcinogenic effects, which had initially been identified in animal studies. This new phase in the history of occupational cancer and of the adverse effects of new materials did not, surprisingly, make it into the book. What shines through all of the editions authored by Hunter, but which can never be captured in the more recent multi authored ones, is his personal enthusiasm for what Legge termed the romance of industrial diseases. Hunter showed this not only in his book, where the dramas are both scientific and political, but also in his teaching. As we write T.C. can recall a 1-h lecture from Donald Hunter on the London School of Hygiene MSc course in 1973. The lecture actually went on for over 2 h and kept the audience transfixed. Hunter arrived with a large cardboard box and, like a magician, took out one item after another, while using each to tell the tale of disease and prevention associated with it: electricity meters, accumulators, bits of wool, rock drills, metal working tools etc. Diseases of Occupations reflects the personality of its author, an enthusiast with unrivalled expertise both in current practice and in the long history of our subject. He succeeded in evoking a similar response in many of his readers. References 1. Hunter D. The Diseases of Occupations . London : English Universities Press . Editions 1–5 . 1955 , 1957, 1962, 1969, 1975. 2. Hunter D. Hunter’s Diseases of Occupations . London : Edward Arnold . Editions 6–10 . 1978 , 1987, 1994, 2000, 2010. 3. Ellis J. Hunter, Donald. Oxford Dictionary of National Biography .http://www.oxforddnb.com/view.printable/312 66 ( 12 July 2017, date last accessed ). 4. Melling J , Carter T. History and development of occupational medicine .In: Baxter PJ , Aw TC , Cockroft A , Durrington P , Harrington JM , eds. Hunter’s Diseases of Occupations . London : Hodder Arnold ; 2010, 5 – 7 . 5. Hunter D. The Diseases of Occupations . 5th edn . 1975 ; 381 – 382 . 6. Hunter D. The Diseases of Occupations . 5th edn . 1975 ; 884 – 908 . © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. 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Occupational Medicine – Oxford University Press
Published: May 17, 2018
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