Toxic Airs: Body, Place, Planet in Historical Perspective

2. Surgeon Reginald Orton and the Pathology of Deadly Air: The Contest for Context in Environmental Health

23 The works on cholera of the Anglo-Indian military surgeon Reginald Orton (1790–1835) and of like-minded successors over the remainder of the nineteenth century have much to tell us about why issues involving air and disease have remained troublesome in our own era, both as matters for scientific study and as issues for public response. The goal of this chapter is to explore the problematic status of the atmosphere as a cause of ill health in Western medical heritage before the contemporary era of environmental awareness. From the reception of Orton’s work, and that of others engaged in analogous projects, we can learn much about why issues involving atmosphere/climate and disease remain marginal in our own era, equally as research questions and as areas of policymaking.1 Orton worked at the intersection of ancient medical climatology and modern biomedical reductionism .2 His research might be seen as a pioneering exemplar of a holistic and interdisciplinary paradigm of infectious disease ecology, but instead represents a genre that has been almost completely forgotten.3 Accordingly it is worth exploring its marginalization, both within medical history and more broadly with regard to the ways modern publics are invited to consider the intersection of environment and health. 2 SURGEON REGINALD ORTON AND THE PATHOLOGY OF DEADLY AIR The Contest for Context in Environmental Health Christopher Hamlin 24–––Christopher Hamlin I shall suggest that the reasons for the continued troublesomeness in identifying atmospheric/climatic determinants of disease are both epistemic and contingently historical. With regard to the former, Orton and his contemporaries and colleagues were multicausalists in an era long before mathematical means were available to distinguish the significance and interconnectedness of multiple causes. With regard to the latter, Orton’s story is one of the geography of professional authority. In an age in which scientific medicine was being consolidated in European hospitals and laboratories , explorers of exotic colonial airs and climates were marginalized. Condemned by context in their own age, most remain so in modern histories of medicine in which the colonial remains peripheral and derivative, in which acute attacks are more interesting than chronic exposure, and in which climates /atmospheres are presumed to be innocuous, or, at most, incidental to disease, which is paradigmatically understood as encounters with microbe agents.4 I shall suggest here not only the importance of resisting the temptation to read colonial medicine exclusively in terms of the European mainline but also the importance of recognizing ways of medical knowing that remained prominent and powerful in colonial settings but were never well integrated into European medicine. Studies of atmospheric and climatic determinants of disease exemplify such approaches. Today’s popular press has seemingly reversed assumptions of climatic/ atmospheric innocuousness, but has done so incoherently. A series of recent headlines describes the formidable impact of air pollution on human health in a multiplicity of ways: air pollution “kills”; it “causes,” is “responsible for,” “is linked to,” or “contributes to” deaths.5 The American Lung Association asserts that “breathing polluted air can seriously harm your health and even shorten your life.”6 And its 2011 “State of the Air” report cautions that “over 154 million people [in the United States]—just over one half the nation—suffer pollution levels that are too often dangerous to breathe.”7 The report does not identify a preferred short-term alternative. Such claims are typically vague and unquantified. Is “harmful to health” the same as “causing disease”? Is shortening life the same as causing death? How much damage to health and how many additional deaths are there? The World Health Organization recently estimated that air pollution causes two million “premature deaths” globally per year.8 But here, such gross quantification , so often looked to as the basis for public policy, is complicated by the multiplicity of methodologies employed. Some approaches are prospective and toxicological: they measure exposure to particular pollutants. Others are retrospective and epidemiological: they compare mortality and morbid- Surgeon Reginald Orton and the Pathology of Deadly Air–––25 ity against a variety of measures of atmospheric and environmental quality. Ideally, these approaches should be complementary, but making them so in fact requires juggling a wide range of complicating issues. It also requires confronting philosophical issues of causation—do we look at causes synergistically or individually? How do we assess blame and responsibility when causes are multiple and in most cases long-term and indirect? In part...