publichealth-4d

I want to move on now to consider a couple of particular trades
in relation to the dangers and the hazards of the work place and
of occupations. And the first dangerous trade that I am going to
be looking at is match-making, and we are going to be using the
example from Great Britain in the late 19th century. And then we
are going to be shifting on and looking at asbestos mining during
the 20th century in South Africa.

So let's begin with our consideration of the hazards and the
problems with the match-making industry and how they link with
public health interventions.

This particular case study focuses in on a strike by workers in
the Bryant and May Match Factory in the East End of London in the
1880s. This was the first strike, industrial action, that is, by
unskilled women workers. And the first point to note is that the
strike itself in the 1880s wasn't directly a result of poor
working conditions. The strike itself was connected with the low
wages that were paid to the women workers in the match-making
industry. But the upshot of the strike was that it brought to the
attention of the authorities the relationships between health and
disease, and in particular the dangerous processes that were
undertaken in the match-making industry that posed particular
risks to the health of both men and women within the factories
themselves.

Now, I want to just step back a little and make the point that
many of the epidemiological investigations that had been
undertaken in the 1860s that I mentioned in a previous section
had concentrated on industrial processes of dangerous materials,
and these processes involved the use of hazardous materials such
as lead and phosphorus. Phosphorus itself was used in the
manufacture of matches. Several European nations only permitted
the manufacture of matches with the safer red, or amorphous
phosphorus. However, the use of the more dangerous white
phosphorus was still permitted in Great Britain in the 1870s and
1880s, and this was because white phosphorus was considered to
provide a better strike, a better flame, and it was a match that
could be struck more readily in a variety of places. And a
British parliamentary report from the end of the 19th century
noted, and I quote: "Most people prefer to carry lose matches
about with them in their pockets and ignite them on the walls of
rooms or their trousers or on the furniture," and the safer forms
of phosphorous, the red or the amorphous phosphorus didn't allow
that versatility whereas the white phosphorus did. And so it was
a more popular material to use in the British factories.

There was an increasing concern with the use of the white
phosphorus and the possible links that it had with phosphorus
necrosis which was popularly known as "phosy jaw." Phosphorus is
absorbed into the body in 3 ways: First of all, it's inhaled;
secondly, it finds a route into the body from hand to mouth; and
thirdly, it can be absorbed through the skin. And effectively
what the disease phosphorus necrosis does is to spread an
infection from the gums and the jaw across the face. And the
initial symptoms are rather like influenza, but eventually what
happens is that the whole face becomes inflamed with the
infection, and quite often surgery was resorted to to remove the
diseased bone in the jaw. And you can see in the slide here on
the right-hand side the deformity that has resulted from the
excision of the entire lower jaw after it had become infected
through phosphorus necrosis.

And studies revealed in the 1890s that there were 37 cases of
phosphorus necrosis in the British match-making industry, with 3
deaths. And it was quite a small work force: We are talking about
the number of people employed in the match-making industry is in
their thousands, very low thousands, maybe 3, 4 thousand people
across the United Kingdom. So it is rather a large number of
cases and number of deaths for such a relatively small work
force.

Now there were some interventions at a relatively early stage to
make sure that the levels of exposure to white phosphorus were
restricted. So in the 1864 Factory Act, for example, children
were disallowed from being involved in the dipping process, and
women and children were not allowed to eat near dangerous
processes. So effectively what was happening here was that there
was, there were certain parts of the process for making the
matches when the wood match was dipped into the phosphorus,
children were not allowed to be involved in that particular
process because they would have been exposed to the phosphorus
itself.

That particular intervention was to do with the specific process
of making matches. The 1895 Factory Act increased the role of
medical inspection, and it instituted the notification of
industrial diseases. And phosphorus necrosis was one of those
diseases that came to be compulsorily notifiable by the factory
physician or by the family doctor. And one of the reasons why
health and disease came to be so important within the match-
making work place is that Bryant and May, the factory where there
had been a strike in the late 1880s by the female workers, that
factory, Bryant and May, failed to notify 3 cases of phosphorus
necrosis in 1898. That failure and the highlighting of the
dangerous exposure to white phosphorus that was still practiced
in the British companies led to a parliamentary report on the
match-making industry in the late 1890s.

And the ensuing report concentrated on 2 particular aspects of
the match-making industry. First of all, it concentrated on the
workers' practices, and particularly the way in which the workers
conducted themselves in hygienic terms within the factory. So
there was criticism that the workers failed, for example, to wash
their hands on a regular basis to make sure that the hand-to-
mouth passage of phosphorus into the body was restricted.
Secondly, the report recommended that certain structural
improvements within the factory should be undertaken, such as
ventilation and also the use of mechanization in the match-making
process, which would reduce the amount of hand contact and bodily
contact with the white phosphorus.

You can see in this representation from the cutting and packing
of matches the sort of impact that mechanization might have. You
can see here the cutting and packing of the matches, which was a
relatively low-skilled task within the match-making industry,
tended to be dominated by women. But also, you have very close
and intimate contact with the white phosphorus that was on the
ends of the matches as they were being packed into the boxes.

What the parliamentary report failed to do, however, was to
actually restrict the use of the white phosphorus itself. So the
main hazard in the work place was not controlled at all: the
white phosphorus itself. And it wasn't until 1910 that the use of
white phosphorus was banned in the work place. And the point
about this is that the public health intervention and legislation
was relatively ineffective in reducing the risk from white
phosphorus. And the public health arguments were subsumed under
arguments over consumer preference for matches made with white
phosphorus and also from the threat of foreign competition. So
the idea was that British companies had to make themselves more
competitive, and if that meant using a relatively more dangerous
material, then so be it. It was the economic considerations that
overrode the health considerations.

The final argument was that the role of medical inspection and
the possible increase in medical inspection, and particularly of
women, would frighten women off from working in the match-making
industry. So in other words, the argument was put about that
women would resist intervention in the work place that involved
them being submitted to medical examinations and medical
inspections for the evidence of disease, and that this would
restrict their entry into the work place and would therefore
reduce the profitability of the match-making businesses.

So what we have here is an example of a specific disease related
to a specific industrial process, and intervention to improve the
health of the work force was delayed and was subsumed by economic
considerations.

And so what I want to do in the next section is to move on and
consider similar things in relation to occupation and disease,
but this time taking the example of asbestos mining in South
Africa during the 20th century.