Charles Levenstein, Gregory F. DeLaurier, and Mary Lee Dunn. The Cotton Dust Papers: Science, Politics, and Power in the "Discovery" of Byssinosis in the U.S. Amityville, NY: Baywood Publishing Company, 2002. xi + 160 pp. $32.95 cloth.
This book chronicles the development of knowledge and social measures around the occupational disease from breathing cotton dust, byssinosis. It covers the U.S. in the period before the enactment of the Occupational Safety and Health Act of 1970. In this Stone Age of industrial medicine in America, particularly in the company towns of the south, the mill owners were a law unto themselves, and they used their power to thwart any form of union activity.
The U.S. and U.K. were leading producers of textiles when Britain recognized byssinosis as a compensable occupational disease in 1940. Four years later, a U.K. industry delegation noted the U.S. technical superiority in all areas but safety (machine guarding) and health (dust control). The U.S. industry's relative success in avoiding the expenses of preventing and compensating byssinosis was attributed to the relative weakness of labor in the U.S., where most of the textile industry had moved to the south between 1920 and 1940 and faced no union "problems" as had occurred earlier in Massachusetts and in Britain.
Byssinosis was well known among the mill workers when Harvard industrial hygienist Philip Drinker was asked to conduct a survey by the federal government toward the end of World War II. Drinker did no medical or worker surveys but wrote that the health records in the cotton textile industry were good and there was "nothing inherently unhealthful" while also remarking about the dust and heat. After this was published as a government report in 1945, Drinker persuaded several companies to support research at some cotton textile plants. The executives who were interested in patenting new inventions that might result, appreciated Drinker's readiness to agree to the companies having authority to approve in advance of any work published.
Drinker's associate, Leslie Silverman, conducted the studies and made a report on them at the annual meeting of the National Safety Council in 1946. He referred to "two occupational diseases of minor character," mill fever and byssinosis. Corporate officials, distressed about this public disclosure, were familiar with both conditions, their correspondence shows. The Textile Workers Union of America greeted the Harvard reports in its publication as recognition of the disease risk and cheered the use of dust controls in the newer mills. But back then, the union could only hope to get legislatures to consider requiring changes that also increased productivity; and even bills to require air conditioning were defeated by the industry.
By 1950, U.S. Public Health Service (PHS) authors had called for medical surveys in the textile industry, and Silverman urged investigation of the relationship between cotton dust exposure and byssinosis in an industry journal. But the industry shrugged this off easily, and there was little progress for many years.
A lawsuit filed in 1979 naming Liberty Mutual as a defendant led to some disclosures of the historic role of the insurance carrier in the cotton dust problem. In deposition, one physician with the insurer told of being directed to not publish anything about health matters that might cause "hysteria." He admitted that "we were running from" the problem in the 1950s and the early 1960s, trying to minimize claims against insured companies and publishing nothing.
Between 1964-66, the American Conference of Governmental Industrial Hygienists adopted an occupational exposure limit for cotton dust in the workplace air, based on British practice and no new data from the U.S.
The Georgia Textile Manufacturers Association was well aware of an Atlanta speech by British byssinosis authority Richard Schilling; they were also aware of medical reviews on byssinosis published in 1960-62. The Georgia trade group meanwhile prevented the Georgia Division of Occupational Health from studying the problem-by blocking access to plants and records-while denying that the problem existed. This is consistent with the history of other industry trade associations (tobacco, asbestos, lead) as focal points for gathering and coordinating responses to independent reports of health problems.
The book describes the struggle of Dutch byssinosis expert Arend Bouhuys, who came to work in the U.S. in the 1960s. Though originally frustrated in Georgia, he was able to conduct laboratory studies and cast his net to find U.S. cases. He readily obtained the cooperation of Dr. Kaye Kilburn in gaining access to records and patients of the U.S. Veteran's Administration. Bouhuys' report of 22 cases established the presence of byssinosis in the U.S.
The authors make a persuasive case that the social unrest of the 1960s was an active force on this scene. Young doctors, one hired by Fieldcrest Mills and the other by the U.S. PHS, examined 509 workers and found byssinosis in 63, the most serious form of the disease in 20. As his term of service with the PHS ended in 1968, Dr. Peter Schrag sent a manuscript to the company that he wanted to publish. The company refused to allow any publication, invoking Schragg's written agreement to not publish anything without obtaining approval from the company. The impasse was fortuitously broken when a U.S. Center for Disease Control agency published an abstract of Schrag's report. This led to a newspaper story, and Schrag was quickly invited to Yale by Bouhuys to discuss his findings. Bouhuys urged that the study's medical importance trumped any reason to block its publication. Meanwhile, Schrag's former bosses at PHS pressed him to change his "suicidal course." He had already threatened that he and his coauthor (who had left Fieldcrest) might publish independently or turn the results over to Ralph Nader. Schrag later did take the issue to Nader, who had grown up in a cotton mill town. Nader, who had supported the Black Lung struggle of coal miners, helped in 1971 to mount a public campaign over what he called "Brown Lung: The Cotton Mill Killer."
The authors of The Cotton Dust Papers describe the joining of forces that led to President Johnson's introduction of the Occupational Safety and Health Act in 1968, spearheaded by labor activists and some unions. The coalition included consumer and environmental groups and drew strength from the historic context of massive social movements over civil rights and the Vietnam War. Influenced by growing industry concern about its image and aware of Peter Schrag's insistence that his medical study at Fieldcrest be made public, a senior executive for the industry leader made the decision to examine thousands of employees for byssinosis. Burlington Vice President Calvin Michaels hired an impressive group of occupational health professionals, and their medical and industrial hygiene survey was done in 1970. Burlington's judgment in acknowledging the need for dust control was justified by its overall technological advantage over smaller competitors; and it was vindicated shortly afterward when the number two firm, J. P. Stevens, faced a national boycott campaign.
The book describes the efforts of numerous individuals who tried in various ways to bring about progress on byssinosis prevention. It closes with an analysis of themes drawn from this and other historical accounts of occupational health issues. It emphasizes the importance of combining labor union activism with the commitment of public health professionals and organizations. It urges that unions employ their own doctors, epidemiologists, industrial hygienists, and safety engineers, while pressing academic institutions to create sympathetic enclaves and working with other activist non-governmental organizations.
It is unfortunate that The Cotton Dust Papers cannot draw greatly upon archives of internal corporate documents and trade association minutes, because there was very limited civil litigation and associated discovery over byssinosis in the U.S. Other reviews of the public health histories of lead poisoning and vinyl chloride (G. Markowitz and D. Rosner, Deceit and Denial, Univ. California Press, 2002) and asbestos (G. Tweedale, Magic Mineral to Killer Dust, Oxford Univ. Press, 2000; B. Castleman, Asbestos: Medical and Legal Aspects, 4th Ed, Aspen, 1996) have had the advantage of access to vast documentation unearthed in litigation. These accounts contain extraordinary glimpses of the actual reactions of giant corporations to the dawning public revelations that their profits were substantially derived from the externalization of social costs, principally in the form of death and disease to workers, consumers, and even infant children. Yet other thorough accounts have been written, like this one, based on government and university archives, diverse published sources, and interviews, about silicosis in the U.S. (D. Rosner and G. Markowitz Deadly Dust, Princeton Univ. Press, 1991; and M. Cherniak, The Hawk's Nest Incident, Yale Univ. Press, 1986) and asbestos in South Africa (J. McCulloch, Asbestos Blues, Indiana Univ. Press, 2002).
BARRY I. CASTLEMAN
Copyright Journal of Public Health Policy 2003
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