AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:S1–S2 (2015)
Editorial
History and Medicine—The Case of Silicosis
In 1995 the International Labour Organisation (ILO) and
World Health Organisation launched a campaign to eliminate
silicosis, based on the notion that the knowledge and means
required for its elimination were within our reach [Fedotov
and Eijkemans, 2007]. Despite this vision, silicosis is still
very much with us, whether in the epidemic form identified in
the South African mining industry [Rees et al., 2009], in less
visible epidemic form in a multitude of small operations in
India [Jindal, 2013] or in outbreaks in novel settings [Kramer
et al., 2012; Akgun et al., 2015]. At the political level, current
efforts in the US to reduce the risk of silicosis and other silica
related diseases have been stalled by representatives of
corporate interests [Rosner, 2014].
The persistence of this ancient hazard and the complex
relationship between silica and silicosis and other diseases
associated with them, is reflected in ongoing research interest
in the subject. A perusal of published English literature
reveals an increased number of mechanistic studies explor-
ing inflammatory pathways and genetic markers, continuing
interest in complications such as lung cancer and autoim-
mune disease, and a plethora of silicosis case studies and
industry surveys particularly from developing countries. A
parallel history literature illuminates silica and silicosis
discourse, regulation and compensation and the social forces
shaping these processes [for example, Rosner and Marko-
witz, 2005; McCulloch, 2012]. This literature makes clear
that how a society defines and compensates silicosis, and
occupational disease more generally, is as much socially
determined as biomedically defined.
This conjunction of social and scientific processes
makes silicosis a rich seam for interdisciplinary research. To
this end, researchers associated with the Centre l’Etudes
Europeennes at Sciences Po, have chosen to shine a light on
the international conference held in Johannesburg in 1930.
Convened in a city barely 45 years old, the conference was to

Correspondenceto:Prof.R.Ehrlich, School of Public Health and Family Medicine,Univer-
sity of CapeTown,Observatory 7925, South Africa.E-mail: rodney.ehrlich@uct.ac.za
Accepted 5 August 2015
DOI 10.1002/ajim.22528. Published online in Wiley Online Library
(wileyonlinelibrary.com).
ß 2015 Wiley Periodicals, Inc.
be highly influential in securing international expert
agreement on the nosology and etiology of silicosis, and
paved the way for inclusion of silicosis in an ILO convention
on compensation for occupational diseases four years later.
The significance of the location lay in the fact that South
Africa, a new political entity in the early stages of a mining
led industrialization, had concentrated both a lethal epidemic
of silicosis and related tuberculosis [Katz, 1994], and
pioneering expertise in medicine, radiology, pathology and
dust measurement. It was thus on the Witwatersrand, the
gold-bearing ridge of which Johannesburg was the center,
that the International Labour Office and the Transvaal
Chamber of Mines, the industry association, convened this
international gathering on 13–27 August, 1930.
The papers that make up this special issue of the AJIM are
drawn from presentations at a 2013 Colloquium, held at
Sciences Po, in partnership with Columbia University, entitled
From silicosis to silica hazards: an experiment in medicine,
history and the social sciences, and part of a European
Research Council funded project bringing together expertise
in history, sociology, pathology, occupational medicine and
mineralogy [http://www.sciencespo.fr/silicosis/fr]. A reading
of the papers revised for this special issue suggests at least
three levels of exploration. The first can be characterized as
institutional history—the illumination of conflicting aims and
agendas of the participants and organizing entities of the 1930
conference, the interests that were served by the resolutions
that emerged, and the subsequent impact of these resolutions
in South Africa and internationally. The second concerns the
history of medical or scientific ideas—in this case, the lasting
influence of decisions made at the conference on biomedical
conceptualization of silica and silicosis, specifically, the
authors argue, a narrowing influence which remains with us
today. The third level is perhaps the most ambitious. This
involves adopting, as it were, a counterfactual position to the
one that emerged from the conference, and refocusing,
through epidemiological and laboratory investigation using
modern techniques, on silica as an agent with etiological
effects across a wider spectrum of pulmonary and systemic
disease than the one “truncated” in 1930.
The prevention of silicosis requires environmental
controls. However, there is much that is still unappreciated
S2 Ehrlich
about silicosis, such its extensive pre-radiological phase
[Hnizdo et al., 1993], and much that is poorly understood
about silica, such as the mechanisms of its tuberculogenic,
carcinogenic and autoimmune effects. Intensified attention to
these questions may also bring wider rewards, for example, in
the understanding of the interaction between infectious and
non-infectious agents in disease causation, the nature of
immune disturbance by mineral agents and the relationship
between fibrosis and carcinogenesis. Even more general is the
untapped potential of an approach that entrains history and
medicine in a joint effort to re-examine the ways in which
ideas about disease are formed. By revealing the origins of
established habits of thought and practice, such joint effort
may open new paths, or re-open old paths, of investigation into
a number of disease entities, occupational or otherwise.
Rodney Ehrlich
Centre for Environmental and Occupational Health
Research, University of Cape Town, South Africa
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Disclosure statement: Prof. Ehrlich has written expert reports for use in silicosis
litigation.