Editorial Note: Sally’s first Go Figure post with its 100 comments outlines the basic dilemma facing RxISK – how can anyone who has been injured by treatment get people who have not yet been injured to wake up. The next 5 – 10 posts will pick up various ways this dilemma has been answered over the last century. All comments welcome along with any posts – something more than a comment – anyone figures they have.
In 1861, the Furth Provincial Medical Association reported on mercury poisoning among mirror workers in the Furth-Nuremberg area. Along with Venice, Nuremberg was a center of the European mirror industry. The first Guild for Mirror Makers opened here in 1373. The craftsmen were using a technique developed in Venice of silvering the backs of mirrors with a mercury tin amalgam to improve the reflection.
The workers were suffering. Few complained. Their problems were only detected when they came to the doctor with other issues or if some new treatment, such as electrotherapy appeared, that some workers figured might be worth getting the doctor to try to manage the problems they were having.
The workers could see in the mirror exactly what mercury was causing when doctors hadn’t – a flush, tremors, irritability, and madness. It caused their feet to burn or go numb.
But against these risks, the only cure was to stop working which brought the certainty of pauperism and maybe death. So the workers lied to their doctors out of fear of losing their jobs. Besides pay was tied to risk – make the job safer and the rates of pay were likely to drop. Did they want a safer job or more pay? The factory owners denied the link.
Mercury had been causing problems for centuries. It was used in felt hats and caused confusion and disorientation to hatters, leading to the phrase Mad as a Hatter and to the Mad Hatter in Alice in Wonderland in 1865.
Administered as a paste for syphilitic sores from 1600 onwards it seemed to help them heal. This led to its use internally and after 1780 to the use of the stronger form – mercuric chloride or Calomel. Soon after this began to be used widely, dementia paralytica appeared, a psychotic disorder commonly put down to syphilis but which only happened where mercuric chloride was used in its treatment. The combination of syphilis and mercury likely did for Mozart (kidney disease), Beethoven and Schubert. See The Day the Music Died.
But in 1861 the link between mercury and health problems, always known at one level but persistently denied, didn’t go away. Adolf Kussmaul, a university physician, agreed with the link the Furth “general practitioners” were proposing.
There was another factor. Chemistry was flourishing and Justus Liebig and others came up with alternate ways to silver mirrors. Mercury was no longer needed and in 1886 its use for silvering was banned.
Faced with a plague, many of us emigrate, a smaller number stay and resist, but most of us get on the train. It is only if there are options that anything else happens. In Furth there were options in terms of new ways to make a living and perhaps some unusual doctors.
In 1848, revolutions across Europe led to changes of government. Doctors played a big part in these uprisings as they had in Paris in 1790. Two of the revolutionaries in Germany, Rudolf Virchow and Karl Marx, had an enduring impact on politics and healthcare politics. Virchow saw doctors as a revolutionary class, where Marx saw workers.
Industrial health issues, exactly like those the Furth mirror workers demonstrated, triggered the formation of a German Workers Association in 1863. A German Socialist party appeared in 1869. There was a growing number of strikes. In 1869, the response from Bismarck, the German Chancellor, was a Factory Act that left owners free of obligations other than those they voluntarily took on. Factories were regarded as private property – not part of the public realm, and not subject to inspections.
In 1875, the Worker’s Association and Socialist party merged to form the Socialist Workers Party, later the Social Democrats. The socialists accepted the validity of the state and the need to work with its institutions to bring about change – workers health and safety were a critical testing ground for whether this was possible.
Industry argued that technology was so diverse and growing so rapidly that it was not possible to legislate in a way that would work. Bismarck again accepted the employers’ argument that money put into health and safety was a tax on jobs and at a time of growing international competition this was not in the national interest.
In 1878, he enacted a set of punitive Anti-Socialist laws.
But he also took another step. Just as the Republican President Dwight Eisenhower put in place a program of interstate highway construction in the United States in the 1950s as a form of state socialism, so in the 1880s Bismarck put State sponsored health insurance schemes on the table as a means to stave off revolution:
“A duty of a state preserving policy should be to cultivate the conception among the non-propertied classes which form at once the most numerous and the least instructed part of the population that the state is not merely a necessary but a beneficent institution”.
The certification or not of workers as sick was a new role that opened up for doctors, a source of income. But it also made them part of the apparatus of the State. They “matured”. As Adolph Beyer in a lecture to the German Association for Public Health in 1877 put it:
“Precisely in this field, prudence and caution are necessary and one should not try to support a safety which risks or neglects the main priority, the securing of the daily bread. That is why it is necessary to openly oppose those immoderate demands which hide behind their pleasant mask of safety and humanitarian ends quite different aims. One should not let emotions reign, but considerations and experience”.