Then came the Hoover
- Allergy: The History of a Modern Malady by Mark Jackson
Reaktion, 288 pp, £25.00, May 2006, ISBN 1 86189 271 3
The term ‘allergy’ was coined in 1906 by the Viennese paediatrician Clemens von Pirquet to denote any kind of biological reactivity, including asthma, hay fever, reactions to insect bites and stings, and the immunological effects of vaccines and natural infections. Some influential contemporary specialists thought the new term to be both wrong and unnecessary. Wrong, because the evidence linking the different manifestations of the condition was weak; and unnecessary, because there were other neologisms with much the same meaning: ‘hypersensitivity’, introduced by Emil von Behring in 1894, and ‘anaphylaxis’, invented by Charles Richet and Paul Portier in 1902. Von Pirquet won. The linking evidence has turned out to be very strong. And although Nobel Prizes were awarded to Behring (in 1901) and Richet (in 1913) for their immunological researches, their terms, unlike ‘allergy’, remained scientific and technical.
What makes a malady modern? Some define themselves as such because they are caused by novel microbes, germs that did not exist in antiquity. The first sound evidence of an infection with the human immunodeficiency virus (HIV) comes from a blood sample taken in Leopoldville in the Congo in 1959, and Aids was first seen in New York, Los Angeles and San Francisco in 1981. The spread of HIV/Aids was affected by modern lifestyles and technology: there is no doubt that it was helped by male flight attendants having sex with many men when they were away from home. But there is nothing particularly modern about the worldwide spread of a sexually transmitted microbe by chronically infected long distance travellers. The hypothesis that the sailors on Columbus’s ships spread syphilis from the New World to the Old is still a sound one.
Other maladies are modern because their causes relate to modern technology. Asbestos was used in antiquity: the wicks of the lamps of the vestal virgins were described as ‘asbesta’ – inconsumable – and those who weaved the wicks wore masks for protection. But its use two thousand years ago was trivial, and remained so until the end of the 19th century. In 1880, world production was 500 tons. In 1967, it was 3,500,000 tons. Airborne asbestos causes pulmonary fibrosis – asbestosis – and malignant mesothelioma. Forty to 50 per cent of smokers with asbestosis die from lung cancer. Malignant mesothelioma is a tumour of the membranes lining the chest. It kills more than a thousand people in the UK every year, mostly older men who worked in industries such as shipbuilding. Mortality rates are predicted to go on rising because significant reductions in exposure to asbestos didn’t happen until the mid-1970s; malignant mesothelioma is a disease of our time because it takes four decades and more to develop.
A subset of maladies that are modern because they relate to new technologies are the iatrogenic: those caused by medical innovations. X-rays were introduced into clinical practice extraordinarily quickly. Wilhelm Röntgen discovered them in November 1895. On 22 December he X-rayed his wife’s hand, and six days later he gave a paper on the subject to the Würtzburg Physical-Medical Society. Within two weeks newspapers had carried the story round the world. Crookes vacuum tubes, Röntgen’s X-ray source, were easy to get; their clinical use began in January 1896. A common claim in hospital histories, particularly those of the celebratory kind, is that the institution being written about was one of the first, if not the first, to use X-rays for diagnostic purposes. All these histories are nearly correct in the sense that the introduction happened in many places simultaneously. The early workers paid a heavy price for their enthusiastic use of unshielded tubes and long exposures. Painful progressive destructive dermatitis was followed by malignant skin cancers. Anaemia killed others. A definitive list of the radiologists, technical assistants and Crookes-tube assemblers (who tested them on their own skin) killed by X-rays doesn’t exist, but hundreds are known to have died directly from radiation-induced disease.