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Watching Paint Dry: Organic Solvent Syndrome in late-Twentieth-Century Britain

Published online by Cambridge University Press:  26 July 2012

Anne Spurgeon
Anne Spurgeon
Affiliation:
Centre for the History of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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In 1856 a Parisian physician called Auguste Delpech presented a paper to the French Academy of Medicine in which he described the strange behaviour of workers employed in the production of India rubber. Many of these men, Delpech reported, had symptoms of mental derangement resembling acute alcohol intoxication. They suffered from impaired memory, vague and confused thoughts, restlessness and insomnia. In particular, they exhibited changeable moods of hilarity and manic outbursts followed by drowsiness, apathy and inertia. The source of the problem, accurately identified by Delpech, was the inhalation of large quantities of a highly neurotoxic compound called carbon disulphide. This was used to soften and spread the latex gum in order to produce rubber sheets. Early rubber making was largely a cottage industry, carried out in poorly ventilated workrooms. With the expansion of the industry into larger scale production during the second half of the nineteenth century, further reports of “insanity” associated with rubber manufacture began to appear in the medical literature. In 1902, the physician Thomas Oliver, reporting on the British Committee on Dangerous Trades of 1899, described episodes during the manufacture of mackintoshes in which workers suffered from “an extremely violent maniacal condition whereby, in their frenzy, [they] have precipitated themselves from the top rooms of the factory to the ground”. It was further observed that the windows of rubber vulcanizing rooms were frequently barred as a preventive measure.

Type
Articles
Information
Medical History , Volume 50 , Issue 2 , 01 April 2006 , pp. 167 - 188
Copyright
Copyright © The Author(s) 2006. Published by Cambridge University Press

References

1 A Delpech, ‘Notes sur les accidents que développe, chez les ouvriers en caoutchouc, l'inhalation du sulfure de carbone en vapeur’, Gaz. Hebd. méd. Chir., 1856, 3 (3): 41.

2 Thomas Oliver, ‘Indiarubber: danger incidental to the use of bisulphide of carbon and naptha’, in Thomas Oliver (ed.), Dangerous trades, London, John Murray, 1902, p. 472.

3 For example, in Europe in 1976, solvent use in paints alone was estimated at 1.8 million tonnes. Figures for various types of solvent usage during the 1970s and 1980s in the European Union can be found in Solvents in common use: health risks to workers, Publication No. Eur 11553 of the CEC Scientific and Technical Communication Unit, Report prepared by the Royal Society of Chemistry for the CEC, Brussels–Luxembourg, CEC, 1988, p. 6. In 1984 approximately 49 million tons of industrial solvents were produced in the United States. Figures from NIOSH Current Intelligence Bulletin 48: Organic solvent neurotoxicity, US Centers for Disease Control, National Institute for Occupational Safety and Health, Cincinnati, 31 Mar. 1987, p. 2.

4 In 1987 it was estimated that approximately 9.8 million workers in the US alone were potentially exposed to solvents. Ibid., NIOSH Current Intelligence Bulletin 48, p. 1.

5 Ethel Browning, Toxicity of industrial organic solvents, London, HMSO, 1953, p. 78.

6 Helena Hanninen, ‘Psychische symptome bei schwefelkohlen-stoffvergiftung’, in XIVth International Congress on Occupational Health, International Congress Series, No. 62, Amsterdam, Excerpta Medica Foundation, 1964, vol. 2, pp. 894–7.

7 The name by which it is most commonly known, although it has different names in different countries, for example, “toxic solvent syndrome” and “psycho-organic syndrome”, and “solvent related chronic toxic encephalopathy”.

8 G Triebig and J Hallermann, ‘Survey of solvent-related encephalopathy as an occupational disease in European countries’, Occup. Environ. Med., 2001, 58: 575–81.

9 Allard Dembe, Occupation and disease: how social factors affect the conception of work-related disorders, New Haven and London, Yale University Press, 1996, pp. 1–3.

10 As discussed by Charles E Rosenberg, Explaining epidemics and other studies in the history of medicine, Cambridge University Press, 1992, pp. 305–18; John Pickstone ‘Introduction’, in idem (ed.), Medical innovations in historical perspectives, Basingstoke, Macmillan Academic and Professional, 1992, pp. 1–16; Jennifer Stanton ‘Introduction: On theory and practice’, in idem (ed.), Innovations in health and medicine, London and New York, Routledge, 2002, pp. 1–18.

11 Dembe, op. cit., note 9 above, pp. 229–58.

12 H Hanninen, ‘Twenty-five years of behavioral toxicology within occupational medicine: a personal account’, Am. J. Ind. Med., 1985, 7: 19–30.

13 Hanninen, op. cit., note 6 above.

14 Hanninen, op. cit., notes 6 and 12 above.

15 Rachel Carson, Silent spring, Greenwich, CT, Fawcett Publications, 1962.

16 Ibid., p. 169.

17 Ibid., p. 176

18 Christopher C Sellers, Hazards of the job: from industrial disease to environmental health science, Chapel Hill and London, University of North Carolina Press, 1997, pp. 227–40.

19 See, for example, the section on ‘Occupational Cancer’ in Donald Hunter's The diseases of occupations, 5th ed., London, English Universities Press, 1975, pp. 774–92.

20 Behavioural research on low-level exposures in the workplace was discussed at governmental level in the US for the first time at a meeting of the National Institute for Occupational Safety & Health (NIOSH) in 1974. See C Xintaras, B L Johnson and I de Groot (eds), Behavioral toxicology: early detection of occupational hazards, NIOSH Publication No. 74–126, Washington, NIOSH, 1974; J D Repko, B B Morgan and J A Nicholson, Behavioral effects of occupational exposure to lead, HEW publication, no. (NIOSH) 75–164, Cincinnati, Ohio, US Dept. of Health, Education, and Welfare, Public Health Service, Center for Disease Control, NIOSH, 1975; D B Chaffin, B D Dinman, J M Miller, R G Smith, and D H Zontine, An evaluation of the effects of chronic mercury exposures on EMG and psychomotor functions, HSM 099-71-62, Washington, DC, US Dept. of Health Education and Welfare, NIOSH, 1973.

21 W Kent Anger, ‘Workplace exposures’, in Z Annau (ed.), Neurobehavioral toxicology, London, Edward Arnold, 1986, pp. 331–7, on pp. 331–4.

22 C Xintaras and B L Johnson, ‘Behavioral toxicology: early warning and worker safety and health’, in Wayland J Hayes Jr (ed.), Essays in toxicology, vol. 7, New York, Academic Press, 1976, pp. 155–201.

23 G Markowitz and D Rosner, Deceit and denial: the deadly politics of industrial pollution, Berkeley, University of California Press, 2002, p. 122.

24 H Hanninen, ‘Psychological picture of manifest and latent carbon disulphide poisoning’, Br. J. Ind. Med., 1971, 28: 374–81.

25 Tests of intellectual functioning, used in Britain, originated in the psychometric work of Francis Galton. Francis Galton, Inquiries into human faculty and its development, London, Macmillan, 1883; see also G C Bunn, ‘Introduction’, in G C Bunn, A D Lovie and G D Richards (eds), Psychology in Britain: historical essays and personal reflections, Leicester, BPS Books, 2001, pp. 1–29, on p. 2. Use of tests in British occupational psychology began during the First World War to investigate industrial fatigue in munitions workers, with the aim of maximizing production, see Ministry of Munitions, Industrial fatigue and its causes, Health of Munitions Workers Committee, Memorandum No. 7, London, HMSO, 1916; see also Sylvia Shimmin and Don Wallis, Fifty years of occupational psychology in Britain, Leicester, BPS Books, 1994, pp. 3–10.

26 For a summary of neurobehavioural studies carried out in North America and Europe during the 1970s and early 1980s, see Robert B Dick and Barry L Johnson, ‘Human experimental studies’, in Z Annau (ed.), op. cit., note 21 above, pp. 348–87.

27 Herbert L Needleman, ‘Epidemiological studies’, in Z Annau (ed.), op. cit., note 21 above, pp. 279–87, on pp. 282–5.

28 R L Rodnitzky, L S Harvey and L M David, ‘Occupational exposure to organophosphate pesticides: a neurobehavioral study’, Arch. Environ. Health, 1975, 30 (2): 98–103.

29 K S Crump, T Kjellstrom, A M Shipp, A Silvers, A Stewart, ‘Influence of prenatal mercury exposure upon scholastic and psychological test performance: benchmark analysis of a New Zealand cohort’, Risk Analysis, 1998, 18 (6): 701–13. This longitudinal study began in 1977.

30 Hanninen, op. cit., note 24 above; H Hanninen, L Eskelinen, K Husman and M Nurminen, ‘Behavioral effects of long-term exposure to a mixture of organic solvents’, Scand. J. Work Environ. Health, 1976, 2 (4): 240–55; K Lindstrom, ‘Changes in psychological performances of solvent-poisoned and solvent-exposed workers’, Am. J. Ind. Med., 1980, 1: 69–84.

31 H Hanninen, ‘Psychological test batteries: new trends and developments’, in R Gilioli, M G Cassitto, V Foà (eds), Neurobehavioral methods in occupational health, Oxford, Pergamon Press, 1983, pp. 123–9.

32 F Gamberale, ‘Behavioral effects of exposure to solvents: experimental and field studies’, in M Horváth (ed.), Adverse effects of environmental chemicals and psychotropic drugs. Vol. 2: Neurophysiological and behavioral tests, Amsterdam, Elsevier, 1976, pp. 111–34; M G Cassito, ‘Current behavioural techniques’, in Gilioli, Cassito, Foà (eds), op. cit., note 31 above, pp. 27–38.

33 A Spurgeon, The validity and interpretation of neurobehavioural data obtained in studies to investigate the neurotoxic effects of occupational exposure to mixtures of organic solvents, HSE Contract Research Report. 355/2001, Sudbury, Suffolk, HSE Books, 2001, pp. 7–8.

34 Ibid., pp. 17–18.

35 Similar (although not exactly the same) diagnostic criteria were agreed at two international workshops held in 1985. WHO/Nordic Council of Ministers Working Group, Chronic effects of organic solvents on the central nervous system and diagnostic criteria, Copenhagen, WHO, 1985; E L Baker and A M Seppalainen, ‘Human aspects of solvent neurobehavioral effects: report of the workshop session on clinical and epidemiological topics, Raleigh, North Carolina 1985’, Neurotoxicology. 1986, 7: 43–56.

36 Triebig and Hallermann, op. cit., note 8 above, p. 577.

37 For a discussion of the political context in Denmark, one of the prime movers in the promotion of organic solvent syndrome, see M Johansson and T Partanen, ‘Role of trade unions in workplace health promotion’, Int. J. Health Serv., 2002, 32 (1): 179–93.

38 Triebig and Hallermann, op. cit., note 8 above, p. 576.

39 Personal communication, conference delegate.

40 Hanninen, op. cit., note 24 above; Lindstrom, op. cit., note 30 above; O Axelson, M Hane and C Hogstedt, ‘A case-referent study on neuropsychiatric disorders among workers exposed to solvents’, Scand. J. Work Eviron. Health, 1976, 2: 14–20; H Hanninen, L Eskelinen, K Husman and M Nurminen, ‘Behavioral effects of long-term exposure to a mixture of organic solvents’, Scand. J. Work Environ. Health, 1976, 2: 240–55; M Hane, O Axelson, J Blume, C Hogstedt, et al., ‘Psychological function changes among house painters’, Scand. J. Work Environ. Health, 1977, 3: 91–9.

41 Personal communication, occupational psychologist at LSHTM.

42 EMAS was formed in 1973 to conduct research and medical investigations. It was a successor to the Medical Services Division of the Department of Employment and published its first report in 1975. Employment and Medical Advisory Service: a report of the work of the Service for 1973 and 1974, London, HMSO, 1975.

43 N Cherry, B Rodgers, H Venables, HA Waldron, G G Wells, ‘Acute behavioural effects of styrene exposure: further analysis’, Br. J. Ind. Med., 1981, 38: 346–50.

44 N Cherry, H Hutchins, T Pace and H A Waldron, ‘Neurobehavioural effects of repeated occupational exposure to toluene and paint solvents’, Br. J. Ind. Med., 1985, 42 (5): 291–300.

45 N Cherry and H A Waldron (eds), The neuropsychological effects of solvent exposure: proceedings of a symposium held at the London School of Hygiene and Tropical Medicine 5–6 Apr. 1982, Havant, Hants, Colt Foundation, 1983.

46 Ibid., p. 26.

47 See, for example, A Derickson. Black lung: anatomy of a public health disaster, Ithaca and London, Cornell University Press, 1998; Geoffrey Tweedale, Magic mineral to killer dust: Turner & Newall and the asbestos hazard, Oxford University Press, 2000; Christian Warren, Brush with death: a social history of lead poisoning, Baltimore, John Hopkins University Press, 2000; R Bayer, ‘Coal, lead, asbestos and HIV: the politics of regulating risk’, J. Occup. Med., 1993, 35 (9): 898–901.

48 Linda Bryder, ‘Tuberculosis, silicosis, and the slate industry in North Wales 1927–1939’, in Paul Weindling (ed.), The social history of occupational health, London, Croom Helm, 1985, pp. 108–26.

49 Derickson, op. cit., note 47 above, pp. 43–59.

50 See, for example, Elaine Showalter, Hystories: hysterical epidemics and modern culture, London, Picador, 1997.

51 Dembe, op. cit., note 9 above, p. 99.

52 Richard Schilling, A challenging life: sixty years in occupational health, London, Canning Press, 1998, pp. 69–80.

53 British physicians have increasingly emphasized the predominance of psychosocial over physical factors in the development and maintenance of musculoskeletal disorders. This has been suggested as a factor in the significant reduction, since 1995, in awards of social security benefits for such conditions. See, J M Harrington, J Hancock, D Gompertz, A Spurgeon, ‘Work-related upper limb pain syndromes – origins and management’, Report on a research priorities workshop, hosted by the University of Birmingham, sponsored by the HSE, 10–11 October, 1995, pp. 8–11, http://www.hse.gov.uk/research/misc/harrington.pdf; Also, G Waddell, M Aylward and P Sawney, Back pain, incapacity for work and social security benefits, London, Royal Society of Medicine Press, 2002, pp. 183–5.

54 Deriving from the recommendations of the Dangerous Trades Committees of the 1880s, these diseases were arsenic, lead and phosphorus poisoning, and anthrax. In 1899 mercury poisoning was added.

55 This exception was anthrax (occurring in the woollen industries), which was established in a landmark case when the House of Lords ruled that the features of the disease (i.e. rapid and fatal, with little doubt of causation) were sufficient for it to be classified as an accident for the purposes of compensation. Brintons Ltd v Turvey, AC 230, 14 April 1905.

56 Ankylostomiasis, a form of hookworm which occurred in Cornish tin miners.

57 Tim Carter, ‘The biology of occupational disease and the pace of prevention: an historical study of UK control measures’, Policy and Practice in Health and Safety, 2003, 1 (2): 83–96.

58 See Roy Porter's The greatest benefit to mankind: a medical history of humanity from Antiquity to the present, London, HarperCollins, 1997, p. 576, for the discovery of various cancer-causing agents during the early twentieth century; pp. 579–80, for the recognition of the contribution of smoking to lung cancer by Bradford-Hill and Doll in 1951; pp. 585–6, for the understanding of various contributors to coronary heart disease following the identification of cholesterol by Brown and Goldstein in the late 1960s.

59 J Malcolm Harrington, ‘Compensation schemes for industrial injuries and diseases’, in P J Baxter, P H Adams, T-C Aw, A Cockcroft and J M Harrington (eds), Hunter's diseases of occupations, 9th ed., London, Arnold, 2000, pp. 37–42.

60 For a discussion of these factors, see University of Birmingham, Institute of Occupational Health, Occupational exposure limits: criteria for the qualitative evaluation of human neurobehavioural studies of neurotoxicity, European Commission, Employment and Social Affairs, Health and Safety at Work series, Report EUR 17390 EN, Luxembourg, Office for Official Publications of the European Communities, 1997, pp. 22–3.

61 A L Cochrane, Effectiveness and efficiency: random reflections on health services, London, Nuffield Provincial Hospitals Trust, 1972.

62 A L Cochrane, ‘A medical scientist's view of screening’, Public Health, 1967, 81: 207–13; A L Cochrane and P C Elwood, ‘Screening – the case against it’, Medical Officer, 1969, 71: 53–7. By the late 1960s Cochrane was already renowned for his epidemiological research on pneumoconiosis in Welsh miners, which he had begun in the 1940s.

63 Cherry and Waldron (eds), op. cit., note 45 above, p. 28.

64 Ibid., p. 28.

65 In the autumn of 1987 the HSE awarded a contract to the University of Birmingham to investigate the neurobehavioural effects of long-term exposure to organic solvents. A Spurgeon, C N Gray, J Sims, I A Calvert, et al., ‘Neurobehavioral effects of long-term occupational exposure to organic solvents: two comparable studies’, Am. J. Ind Med., 1992, 22: 325–35.

66 Triebig and Hallermann, op. cit., note 8 above, p. 576.

67 WHO/Nordic Council of Ministers, op. cit., note 35 above; Baker and Seppalainen, op. cit., note 35 above.

68 Personal communication. Director of Medical Services, HSE.

69 S Bowden and G Tweedale, ‘Mondays without dread: the trade union response to byssinosis in the Lancashire cotton industry in the twentieth century’, Soc. Hist. Med., 2003, 16: 79–95; A J McIvor, A history of work in Britain, Basingstoke, Palgrave, 2001, pp. 111–47, 200–40.

70 Notably Alfred Blyton and Vic Feather.

71 Notably Sheila McKecknie and David Gee.

72 Kenneth O Morgan, The people's peace: British history 1945–1990, Oxford University Press, 1990, pp. 397–433.

73 Ibid., p. 450. Union membership fell from over 13 million in 1980 to under 10 million in 1983.

74 Johansson and Partanen, op. cit., note 37 above, pp. 180–1.

75 This is well illustrated by the recognition of pneumoconiosis as a compensable disease in British miners in 1943. Similar recognition did not take place in the United States until 1969. In the early 1940s, British miners, unlike their American counterparts, were employed in a nationalized industry with a powerful union. Derickson, op. cit., note 47 above pp. 121–2, 151–61.

76 In 1984 there were 232.6 fatal or major injuries per 100,000 employees in the construction industry, compared with 87.4 per 100,000 employees in manufacturing; Health and safety statistics, London, HMSO, 1985.

77 Circular received by the Director of Medical Services, HSE, from the Health Protection Committee of CEFIC, ‘Re: Danish painter's syndrome’, 2 Dec, 1985.

78 P Grasso, M Sharratt, D M Davies and D Irvine, ‘Neurophysiological and psychological disorders and occupational exposure to organic solvents’, Food Chem. Toxicol., 1984, 22 (10): 19–52.

79 For a review of forty-five studies, see Spurgeon, op. cit., note 33 above.

80 These were held at HSE headquarters in Nov. 1985, Nov. 1986 and April 1987. Personal communication from a member of the HSE's Advisory Committee on Toxic Substances.

81 Ibid., April 1987. A consultant psychiatrist was appointed as Senior Employment Medical Advisor for Mental Health in 1973; Employment Medical Advisory Service report, 1975–6, London, HMSO, 1978.

82 Spurgeon, et al., op. cit., note 65 above.

83 A Spurgeon, D C Glass, I A Calvert, M Cunningham-Hill, et al., ‘Investigation of dose-related neurobehavioural effects in paintmakers exposed to low levels of solvents’, Occup. Environ. Med., 1994, 51: 626–30.

84 R Stephens and P Barker, ‘The role of human neurobehavioural tests in regulatory activity on chemicals’, Occup. Environ. Med., 1998, 55: 210–14.

85 Ibid., p. 213.

86 Ibid., pp. 213–14.

87 R Stephens, A Spurgeon, J Beach, I A Calvert, et al., ‘Neuropsychological effects of long-term exposure to organophosphates in sheep dip’, Lancet, 1995, 345: 1135–38.

88 Angela Browning was interviewed on Channel 4 News in Feb. 1995 about the problem of OP poisoning among sheep farmers.

89 For example, two recent histories of lead poisoning mention psychological tests only briefly in the context of childhood poisoning and IQ tests. Markowitz and Rosner, op. cit., note 23 above, pp. 122–3, 135–6; Warren, op. cit., note 47 above, p. 148. However, early concerns about low level lead exposure were based almost exclusively on neurobehavioural data. See, for example, R G Feldman, N L Ricks, E L Baker, ‘Neuropsychological effects of industrial toxins: a review’, Am. J. Ind. Med., 1980, 1: 211–27; also, B Weiss, ‘Behavioral toxicology and environmental health science’, Am. Psychol., 1983, 38: 1174–87.

90 For example, for the effects of low-level methylmercury exposure, see Crump, et al., op. cit., note 29 above. For a discussion of other syndromes, see D E Hartman, ‘Neuropsychological toxicology: identification and assessment of neurotoxic syndromes’, Arch. Clin. Neuropsychol., 1987, 2 (1): 45–65.

91 Two rare examples of published disagreement with the official Danish position can be found in E O Errebro-Knudsen and F Olsen, ‘Organic solvents and presenile dementia (the painters' syndrome). A critical review of the Danish literature’, Sci. Total Environ., 1986, 48 (1–2): 45–67; A Gade, E L Mortensen, P Bruhn, ‘“Chronic painter's syndrome”: a reanalysis of psychological test data in a group of diagnosed cases, based on comparisons with matched controls’, Acta Neurol. Scand., 1988, 77 (4): 293–306.

92 P R Lees-Haley and C W Williams, ‘Neurotoxicity of chronic low-dose exposure to organic solvents: a skeptical review’, J. Clin. Psychol., 1997, 53 (7): 699–712.

93 This was enshrined in the Occupational Safety and Health Act of 1970.

94 Weiss, op. cit., note 89 above, p. 1180.

95 Shimmin and Wallis, op. cit., note 25 above, pp. 3–6, 98–101.

96 There were three university departments in England and two in Scotland.

97 A psychologist and a social worker with training as a psychiatric nurse were appointed to EMAS in 1976. EMAS, op. cit., note 81 above.

98 For a summary of their concerns, see Visual display terminals and workers' health, WHO Offset Publication No. 99, Geneva, WHO, 1987.

99 By 1980 psychologists had established grades linked to national salary structures in the NHS, the Education Department (School Psychological Services) and in the Armed Services.

100 J Hall, T Lavender, and S Llewelyn. ‘A history of clinical psychology in Britain: some impressions and reflections’, Hist. Philos. Psychol., 2003, 4 (2): 32–48.

101 The Register of chartered psychologists and the accompanying Directory of chartered psychologists (those with practising certificates) are published annually, Leicester, BPS.

102 The processes of professionalization in psychology have been less discussed by historians than have aspects of professonalization in medicine. However, see S Lovie, ‘Three steps to heaven: how the British Psychological Society attained its place in the sun’, and Mathew Thomson, ‘The popular, the practical and the professional: psychological identities in Britain, 1901–1950’, in Bunn, Lovie and Richards (eds), op. cit., note 25 above, pp. 95–114, 115–132.

103 Shimmin and Wallis, op. cit., note 25 above, pp. 93–107.

104 Beginning in 1987, standards and competence requirements, with approved training courses, for the use of psychological tests became formalized in: Psychological testing: a test user's guide, Leicester, Psychological Testing Centre of the BPS, 1999, see also http://www.psychtesting.org.uk. Alongside this, NFER-Nelson, one of the main test publishers in the UK, requires purchaser registration and, based on qualifications, issues Test User Codes which determine the level of test which can be purchased by each user.

105The role of psychologists in the health services: report of the Sub-Committee on the Role of Psychologists in the Health Services (Trethowan Report), London, HMSO, 1977.

106 B Stollery and M L H Flindt, ‘Memory sequelae of solvent intoxication’, Scand. J. Work Environ. Health, 1988, 14: 45–8.

107 Spurgeon, et al., op. cit., note 65 above.

108 Spurgeon, et al., op. cit., note 83 above.

109 Stephens, et al., op. cit., note 87 above.

110 The only academic psychological journal concerned exclusively with occupational health in the UK is entitled Work and Stress.

111 R Chen, F Dick and A Seaton, ‘Health effects of solvent exposure among dockyard painters: mortality and neuropsychological symptoms’, Occup. Environ. Med., 1999, 56: 383–7.

112 Triebig and Hallermann, op. cit., note 8 above.

113 The differences in criteria were highlighted by J A van der Hoek, M M Verberk, G van der Laan, and G Hageman, ‘Routine diagnostic procedures for chronic encephalopathy induced by solvents: survey of experts’, Occup. Environ. Med., 2001, 58: 382–5.

114 See, for example, J F Gamble, ‘Low-level hydrocarbon solvent exposure and neurobehavioural effects’, Occup. Med. (London), 2000, 50 (2): 81–102; Lees-Haley and Williams, op. cit., note 92 above.