E. P. Vishnevskaya

The First Russian Book on Occupational Hygiene

On the centenary of the publication of A. N. Nikitin’s Diseases of Workers, with an Indication of Preventive Measures, St. Petersburg, 1847

From the Department of Occupational Hygiene, First Moscow Order of Lenin Medical Institute

A. N. Nikitin (1793–1858) was the first Russian physician to publish articles setting forth particular issues of occupational hygiene, drawing primarily on foreign sources and chiefly on Ramazzini’s De morbus artificum diatriba. The author of numerous and varied works, 48 in all, Nikitin published a series of essays and reviews on occupational hygiene in the journal Drug zdraviya. The first publication of this kind was the article “On Measures for Protection against the Harmful Effects of Mercury on the Health of Gilders” (1843), in which Nikitin described in detail the measures proposed by the Frenchman d’Arcet to make gilders’ work healthier. Drawing on his journal articles, which he supplemented and organized systematically, Nikitin published Diseases of Workers, with an Indication of Preventive Measures in 1847—the first book in Russian on occupational hygiene. A staff physician and later a doctor of medicine, A. N. Nikitin, who grew up in the St. Petersburg Foundling Home and also made it the setting for his many years of independent medical practice, thus secured an honorable place in the history of Russian hygiene. In the preface to his book he writes: “Most trades involve circumstances that expose the health and even the lives of those engaged in them to many dangers, arising either from the harmful properties of the substances being worked or from the methods used to work them. In our social life, the various branches of industry and the arts are among the greatest dangers to life and health. The physician must therefore also pay attention to the trades, in order to become acquainted with the disease-producing causes concealed within them and be able to prevent their effects on the human body.” One may confidently assert that the need to instill such clear principles in the minds of a number of our physicians—and still more of our students preparing for medical practice—remains relevant today.

The purpose of the book is to acquaint physicians, as well as the relevant groups of workers, with the dangers presented by each occupation and to identify the necessary preventive measures. “Wishing, as far as—

...to acquaint our industrial workers, artisans, and others with the hazards attendant upon the practice of their occupations, and to indicate the precautions that they themselves can take, we offer a brief description of the diseases that occur most frequently among people engaged in crafts, trades, and industry. So that tradesmen themselves may benefit from reading our book, we have endeavored to write it in a style intelligible to everyone.”

It is highly significant that Nikitin addressed his work to a broad readership of workers (“tradesmen”), understanding the great importance of health education in preventing occupational diseases.

The book Diseases of Workers consists of 6 sections and 95 chapters and covers the diseases of 120 occupations. The author recognized how difficult it would be for the reader to assimilate such material. He therefore arranged all the occupations under consideration according to the principal groups of occupational hazards. Thus the first classification of occupational hazards was created. We reproduce it here, following the author’s grouping of workers’ diseases according to their etiology.

I. “Animal emanations.” These hazards are characteristic of more than 20 occupations: feldshers, wet nurses, physicians, students studying anatomy on cadavers, fishermen, cooks, sewage workers, gravediggers, and all workers who handle animal products.

II. “Vegetable emanations” are noted in 18 occupations: bakers, tobacco workers, hemp sellers, chimney sweeps, and other workers who are “surrounded by more or less fine dust, which penetrates the respiratory and digestive organs and produces more or less severe irritation there.”

III. Emanations or particles of substances from “the three kingdoms of nature combined.” These include the hazards of such occupations as chemists, apothecaries, sellers of medicinal materials or druggists, water carriers, bath attendants, rowers, market gardeners, and others.

IV. “Modes of carrying out various occupations and kinds of work.” In this section the author considers 26 occupations not directly connected with any form of production. Diseases caused by this group of hazards arise from overexertion of one or another organ. This group includes coachmen, tailors, “street criers,” dancers, hunters, porters, and others.

V. Metallic particles. The occupations considered here involve the working of metals.

VI. Asphyxiating and poisonous gases.

There is no need to dwell on how elementary and scientifically primitive some of the formulations and other details are. It is unquestionably important to note, however, that the first Russian author on occupational hygiene and disease clearly understood that occupational hazards may be associated not only with features of the external environment but also with the nature of the work performed.

Considering the book as a whole, one should note its comprehensive scope, not only in the number of occupational diseases and groups of occupations described, but also in the volume of material used by the author.

A. N. Nikitin not only presents individual observations of his own on workers’ diseases, but also draws on a very large number of Russian and foreign sources, presenting and quoting the views of many celebrated physicians, beginning in remote antiquity. In all, Nikitin cites 75 authors in his book. Among them are Galen, Hippocrates, Ettmüller, Patissier, Dupuytren, Morgagni, Ramazzini, and Lancillotti. He often refers to writers,

poets and philosophers, mentioning, for example, Virgil, Voltaire, Lope de Vega, and others. Nikitin draws on works by Russian authors on related subjects. We encounter the names of Staff Physician Vishnevsky, author of Naval Hygiene; Blashke (Medical Topography of the Port of Novoarkhangelsk, 1842); Engolm (Military Hygiene, 1812); Chetvernin (Military Medical Police); Charukovsky (Military Field Medicine); and Buchan (Domestic Medicine).

When examining books of historical value, it is by no means necessary to look for propositions, observations, or descriptions that remain relevant today. Yet Nikitin’s descriptions of particular diseases and their symptoms are so complete and comprehensive that they have indeed retained their value even now. For example, Nikitin gives a remarkable account of lead poisoning. He first lists the lead compounds that have harmful effects, then identifies a number of occupations exposed to them (painters, porcelain decorators, perfumers, potters, glaziers, engravers, printing workers, and many others), and finally describes the first signs of developing lead poisoning.

As is done today, Nikitin distinguished, as it were, two phases of lead poisoning: the accumulation of lead and lead poisoning proper. He attributed the following symptoms to the first phase: 1) discoloration of the gums and mucous membrane, ulcers on the gums, and damage to the teeth; 2) an astringent taste in the mouth and salivation; 3) lead jaundice; 4) emaciation.

In his account of the clinical manifestations of lead poisoning, his interpretation of lead colic is especially interesting. He defines it as “severe suffering of the nerves of the intestinal canal.” He goes on to say: “The cause of lead colic is spasmodic contraction, but its essence is paralysis of the intestinal canal.” Among the other manifestations of saturnism, he describes lead palsies, sensory disturbances, lead blindness, and brain lesions. Good ventilation is recommended as a means of preventing lead poisoning.

Equally detailed accounts are given of scrotal cancer in chimney sweeps and night blindness in peasants. “With regard to peasants, and especially their children, the following should be noted: in the month of March, peasant children around the age of ten experience weakness of sight and can see somewhat only during the day. This disease, known as night blindness, passes of its own accord without any medicine in the middle of April, and the eyes begin to see as before. During the course of night blindness the pupils are excessively dilated.”

Another great merit of Nikitin’s book is that the author does not confine himself to describing workers’ diseases and their causes, but also attempts to address the question of protecting workers from harmful conditions and dangers.

Nikitin proposes a number of highly sensible and easily implemented preventive measures. For example, before descending into deep wells, he proposes first lowering a burning candle into them—a practice still used today. At the same time, he points out that if the candle does not go out, this is not yet proof that the air is clean, since it may contain hydrogen sulfide, which causes instantaneous loss of consciousness. He recommends that a worker descending into a suspicious well tie a rope around himself so that he can be pulled out quickly. Nikitin also proposes covering the nose with “cotton wool” when harmful gases and dust are released, and covering the ears when noise is loud.

He attaches particular importance to properly designed ventilation, recommending the installation of exhaust systems in most workshops and even—

…providing a detailed description of the construction of an exhaust hood (and, in a separate article, detailed drawings). He especially emphasizes the importance of properly designed ventilation when working with mercury.

One hundred years have passed since the publication of A. N. Nikitin’s book. During that time, and particularly over the 29 years of the Soviet period in the development of our science, occupational hygiene has achieved a high level of development both as a science and as a field of practical work. It is all the more important, therefore, that present-day hygienists understand the origins of hygiene as a science in our country. Nikitin lived and worked in the grim years of tsarist Russia, during the period of serfdom and the brutal exploitation of unfree labor. Although he clearly did not understand how the severity of working conditions depended on the economic system and political circumstances of his time, his contributions to Russian hygiene must be recognized as significant.