Occupational Pathology

OCCUPATIONAL PATHOLOGY, a branch of occupational hygiene (see Occupational hygiene), dealing with the investigation of the relationship between occupational hazards and the general occupational morbidity of workers, and studying the etiology and specific clinical courses of occupational diseases in order to substantiate appropriate preventive, therapeutic, and organizational measures. Therefore, occupational pathology is, on the one hand, in the closest connection with other sections of occupational hygiene (general occupational hygiene in the narrow sense, studying occupational hazards, special occupational hygiene, sanitary labor statistics, labor physiology, occupational toxicology, and industrial sanitation), and on the other hand, with the corresponding clinical specialties (internal medicine, surgery, gynecology, etc.). Unhealthy conditions of the production process and the work environment manifest themselves first and foremost and most frequently not in the form of exclusively exquisite cases of specific occupational diseases, but in their influence on the general morbidity of workers. Furthermore, unhealthy conditions of occupational labor can manifest in the fact that diseases occurring under normal conditions as well, proceed under the influence of certain occupational conditions in more sharp or in special, peculiar forms, affect certain selected systems and organs, and yield a greater number of unfavorably terminating cases than occurs in the norm. Thus, for example, many intoxications and infections, as well as various other diseases, most easily and strongly affect those organs which are in a state of constant overstrain or weakening under the influence of various occupational hazards (e.g., high temperature, occupational poison, etc.). Furthermore, unhealthy conditions of occupational labor can contribute to the emergence or, more correctly, the manifestation of such diseases or pathological states that are associated with congenital or acquired weakness, lesser resistance, or other defects of individual organs or systems, although under other working conditions these individual characteristics might not manifest themselves at all. As an example, one can point to various allergic diseases (in particular, various eczemas or asthma), when the impact of external factors of a production nature reveals a particularly heightened sensitivity of the given person to various specific irritants-allergens. Occupational conditions are also of serious importance in that the very assessment of the state of health as a result of a completed pathological process will often be completely different in clinically identical cases for representatives of various categories of occupational labor. If formerly the clinic set before itself only questions of prognosis "quoad vitam" and "quoad valetudinem", now in the USSR it is not limited only to these moments, but constantly sets before itself also the question of the outcome "quoad functionem". Indeed, that state of health which gives the right to consider the majority of people or that "average" or "abstract" person with whom the clinic so often still operates—not being accustomed to view man not as a biological individual, but as a "social being" (Marx) in his concrete conditions of labor and everyday life—is far from always being such for representatives of various professions. Cases are frequent when, even with a favorable outcome in the usual clinical sense, a certain functional insufficiency remains, hindering the former intensity and quality of work, or when the ever-real threat remains of the renewal of this or that pathological state or disease under the condition of resuming previous work. It should always be further taken into account not only the etiological significance of occupational hazards or unhealthy work environments, but also the possibility of the latter's impact on the course and intensity of diseases arising under the influence of factors of a completely different nature. Myocarditis in a clerk is one thing; myocarditis in a blacksmith is another; a disease of the hearing organs in an engraver is one thing, in a boilermaker another. Finally, it should not be forgotten that recently questions of differentiated occupational therapy are being developed more and more, taking into account the concrete features of the disease course under certain conditions and having as its immediate goal the speedy restoration of working capacity, and in cases not associated with its loss, the struggle for high labor productivity. Occupational pathology substantiates sanitary-preventive health-improving measures of a production order, insofar as it establishes the real significance from the standpoint of the health of the individual worker and the entire working class of individual unhealthy conditions of the labor and production environment, reveals the role and significance also of the quantitative element and the degree (in particular, the duration) of the impact of individual occupational hazards, and thereby directs occupational hygiene along the line of developing and implementing in practice priority measures of special significance both for reducing morbidity and for increasing labor productivity. At the same time, occupational pathology ensures the most rational system of specialization of medical and sanitary services for workers in relation to production conditions, indicating which professions should be singled out for particularly careful observation and regular medical examinations, for particularly enhanced provision with general or specific sanatorium-resort assistance, etc. Finally, occupational pathology develops practical questions of a therapeutic-preventive order directly in the workshops (e.g., washing the skin with neutralizing solutions, applying special dusting powders, etc.) and provides the necessary materials for the correct formulation of medical-labor expertise, closely connected with the peculiar vocational counseling of those who have partially lost their working capacity. Occupational pathology, in studying the impact of labor on health, can never abstract itself from the concrete socio-historical formation and real class relations against the background of which this impact takes place. Labor can never be considered as a purely biological or technical category, equating it to work, as a number of contemporary bourgeois scientists of the West do, and following them some contemporary Soviet labor physiologists and occupational pathologists (Kekcheev, Vigdortchik, etc.). Regularities associated with labor, and in particular with its impact on the health of workers, are by no means any kind of "natural", non-historical laws. As Marx wrote in the "Critique of Political Economy", "the example of labor convincingly proves that even the most abstract categories, despite the fact that precisely because of their abstraction they are valid for all epochs, in the very definiteness of this abstraction are no less a product of conditions and possess full significance only for and within those conditions." At the same time, decisive and determining are indisputably social regularities, and not biological or technical ones. Not the labor processes themselves, not the machine itself, but the production relations of the given social system ultimately determine the general and occupational morbidity of workers. The founders of Marxism-Leninism repeatedly elucidated in their major works a vast body of factual material on the occupational morbidity and traumatism of the working masses under capitalism and essentially laid the theoretical foundations of a truly scientific occupational pathology. Thus, Marx in "Capital" repeatedly speaks of the threat of physical degeneration of the working masses, of the exhaustion of workers, of the exhausting, wearing down, dulling in its monotony and emptiness, and psyche-crippling influence of machine labor under capitalism. Engels in "The Condition of the Working Class in England" also devotes not a few pages to elucidating the impact of capitalist working conditions on the health of the adult worker, the adolescent, the female worker and her germinative function, on the children of workers, etc. But at the same time, they always clearly and definitively emphasize that we are talking precisely about the impact of the capitalist machine, capitalist labor, in a word, capitalism, and not of the machine and labor as such. Thus, Marx writes: "if the machine is the most powerful means to increase the productivity of labor, i.e., to shorten the working time necessary for the production of goods, then, as the bearer of capital, it becomes primarily in the branches of industry directly seized by it the most powerful means to lengthen the working day beyond all natural limits." In another place of "Capital" we read: "There is no doubt whatever that machines in themselves are not responsible for the sufferings which they bring with them." The contradictions and antagonisms inseparable from the capitalist application of machinery do not exist because they spring from the machinery itself, but from its capitalist application. And finally: "It requires a certain time and experience before the worker learns to distinguish between machinery and its capitalist application, and to transfer his attacks from the material instruments of production to the social form of exploitation." Very striking denunciatory pages are devoted to capital by both Marx and Engels when speaking about the health of both individual professions and the entire working class.

Marx comes to the conclusion: "Capital consumes labor power so rapidly that the worker in middle age already turns out to be more or less decrepit"... "Under the capitalist system, all methods for raising the social productive power of labor develop at the expense of the individual worker; all means for the development of production transform into means of subjugation and exploitation of the producer, mutilate the worker, turning him into a fractional man, degrade him to the role of an appendage of a machine"... "The saving of social means of production, achieving hothouse maturity for the first time under the factory system, turns in the hands of capital into a systematic robbery from the worker, engaged in the labor process, of all conditions necessary for life: space, air, light, as well as means protecting the worker from life-endangering or antihygienic conditions of the production process - and as for appliances for the convenience of the worker, there is no need to speak of them. Is Fourier not right when he calls factories 'mitigated galleys'?"... "The physical strength of the worker is weakened and relatively exhausted, as is observed in all countries with developed capitalist production"... "Capitalist production, which is essentially the production of surplus value, the sucking out of surplus labor by lengthening the working day, leads not only to the destruction of human labor power, from which the normal moral and physical conditions of development and activity are taken away. It leads to the premature exhaustion and destruction of labor power itself"... "Experience shows the thoughtful observer how rapidly and how deeply capitalist production, which arose, historically speaking, only yesterday, has already succeeded in undermining at the very root the vital force of the people, how the degeneration of the industrial population is retarded only by the constant absorption of primitively strong vital elements of the countryside, and how even rural workers are already beginning to die out, despite the fresh air and the boundless dominance among them of the principle of natural selection, thanks to which only the strongest individuals survive"... "Capital is merciless toward the health and shortens the life of the worker everywhere that society does not force it to a different attitude"... "In conflict with 'public opinion' or even with sanitary police, capital does not hesitate at all to justify the partly dangerous, partly humiliating conditions into which it places the labor and home life of the worker by the consideration that this is necessary for the more profitable exploitation of the worker. Such is the state of affairs when it renounces appliances for protection against dangerous machines in factories, renounces ventilation and safety measures in mines, and so forth"... Finally, we see a completely clear formulation of the historicity of occupational pathology in the following statement by Marx: "The material and stimulus for industrial pathology (the doctrine of diseases of industrial workers) is given for the first time only by the manufacturing period"... And Engels wrote directly: "We have a whole series of diseases caused exclusively by the disgusting greed of the bourgeoisie. Women who have lost the ability to give birth, deformed children, weak men, broken limbs, infected, exhausted organisms of entire generations - all this is created in order to line the pockets of the bourgeoisie." Thus, occupational diseases and other consequences of the unhealthy organization of labor are here directly and immediately linked with the "greed" of the bourgeoisie. The greatest mistake of the first stage of the development of occupational pathology in the USSR, completely uncovered in the discussion on the ideological front that took place in 1930-1931, was the incomprehension of this historicity of occupational pathology, the approach to labor as a pathogenic factor under all conditions (Vigdortchik's theory of "labor poisoning"), the transfer of capitalist regularities into the conditions of building a socialist society, and the incomprehension of the fundamental difference between the formulation of the labor problem in capitalist countries and in the USSR. Meanwhile, the works of Marx, Engels, and especially the works of Lenin and Stalin sufficiently elucidated this problem. Thus, Engels wrote: "If voluntary productive activity constitutes the greatest enjoyment for us, then compulsory labor is the most cruel and humiliating torture"... "The worker works for money, i.e., for a goal having nothing in common with labor; he labors because he is forced to, and furthermore his labor is so prolonged and so monotonous that for this reason alone it must become a real torture for him." At the same time, Engels wrote in Anti-Dühring that "instead of the division of labor, there must arise such an organization of production in which, on the one hand, no one could shift onto another his share of participation in productive labor as a natural condition of human existence, and, on the other hand, productive labor, instead of being a means of enslavement, would become a means of liberation, providing every personality with the opportunity to develop in all directions and display all their capabilities, both physical and spiritual. Labor consequently must turn from a burdensome duty into a pleasure." Marx already in his critique of the Gotha Program wrote that the time will come "when labor itself will become the primary necessity of life, not only a means of life; when along with the all-around development of the personality, the productive forces will also grow, and all the springs of social wealth will flow abundantly." Lenin elaborated especially thoroughly in a number of his works and articles (especially in his articles "A Great Beginning" and "How to Organize Competition") the question of the specifics of formulating the labor problem under socialism, characterizing it in particular in the following words: "Labor for the benefit of society, labor performed not for the discharge of a certain obligation, not for obtaining the right to certain products, not according to pre-established and legalized norms, but voluntary labor, labor outside of norms, labor given without calculation of remuneration, without a condition of remuneration, labor out of the habit of laboring for the common good and out of a conscious (turned into a habit) attitude toward the necessity of labor for the common good - labor as the need of a healthy organism." Stalin especially vividly defined the character of labor in our conditions, in the setting of socialist forms of labor (socialist competition and shock work). At the XVI Congress of the Party, he said: "The most remarkable thing about competition is that it produces a radical revolution in people's view of labor, for it transforms labor from a heavy burden, as it was considered before, into a matter of honor, a matter of glory, a matter of valor and heroism." At the same time, both Lenin and Stalin clearly pointed to the huge, completely unprecedented opportunities in the field of improving labor conditions created by the socialist revolution. Lenin wrote about this repeatedly, touching upon this issue also regarding the GOELRO plan and the electrification of the country in general, and in connection with the work on introducing the peat-extraction machine (Gidro-torf), and even before the revolution, illuminating the grandiose prospects - which could not possibly be realized under capitalism - of the broad utilization of the Ramsay-Mendeleev invention on the underground gasification of coal, and in a whole series of other articles and speeches. Stalin at the XVI Congress of the Party in turn clearly proved that all socialist construction as a whole "creates such an environment of work and everyday life of the working class as gives us the opportunity to raise a new generation of workers, healthy and cheerful, capable of raising the might of the Soviet country to the proper height and defending it with their chests against attempts by enemies." In the USSR, occupational diseases constitute a category that is essentially dying out, because as further successes of technical progress and the socialist organization of labor proceed, they will decrease so much both quantitatively and qualitatively (in the sense of the degree of impairment of the health of the workers) that in connection with this, occupational pathology will also gradually come to naught with us. Along with this, the positive (organism-forming, tonic, and therapeutic) significance of labor is acquiring greater and greater importance. Of course, this does not mean that occupational pathology will disappear completely in the coming years. On the contrary, this discipline must still develop to its full extent for some time, but in contrast to the past stage, when a number of authors preached the necessity of breaking it away as an independent discipline from labor hygiene due to the process of differentiation of sciences (Levitsky) or due to the fact that its roots lie in pathological rather than hygienic sciences (Vigdortchik), it must be more closely linked with preventive work. This line found reflection in the recent decisions of the People's Commissariat of Health, according to which institutes for the study of occupational diseases have been renamed institutes of labor hygiene and industrial sanitation, and the teaching of the clinic of occupational diseases has been merged into the departments of labor hygiene. Lit.: Vigdortchik N., Professionalnaya patologiya (Occupational Pathology), Moscow - Leningrad, 1930; Kaplun S., Gigiena truda, professionalnaya patologiya i noveyshaya klinika (Labor Hygiene, Occupational Pathology and the Newest Clinic), Sotsialisticheskaya gigiena, 1926, no. 8; Kuznetsov O., Ocherednye zadachi prof. patologii v tekushchiy period stroitelstva sotsializma (Immediate Tasks of Occupational Pathology in the Current Period of Socialist Construction), Gigiena truda, 1931, no. 10-11; Baader E., Gewerbekrankheiten, Berlin, 1931.

Ballhasar M., La reparation des maladies professionelles, P., 1927; Bauer, Die Ausdehnung der Unfallversicherung auf Berufskrankheiten, B., 1929; Bettman, Siegfried, Chajes, Benno, Flury, Ferdinand u. a., Therapie gewerblicher Berufskrankheiten, B.-Wien, 1930; Breton, Les maladies professionelles, Paris, 1911; Handbuch der Arbeiterkrankheiten, herausgegeben von Th. Weyl, Jena, 1908; Koelsch F., Die meldepflichtigen Berufskrankheiten, München, 1926; Roberti Lagarde H., La reparation des maladies professionelles, Paris, 1927. See also the bibliography for the articles Poisoning, Occupational Hygiene, and Occupational Diseases.