Delpech and the origins of occupational psychiatry.

Abstract

Auguste-Louis Delpech (1818-80) has been remembered principally as the author of the first detailed description of the serious consequences of exposure to carbon disulphide. A close reading of his work suggests that his reputation has been seriously undervalued. The subsequent development of occupational psychiatry, with its emphasis on the distinction between the organic and the functional, may be traced through publications on carbon disulphide. It is argued that a contemporary approach to occupational psychiatry is long overdue.On peut dire que le sulfure asassine; il tue l'homme, il lui fait perdre toute dignite tout respect de soi meme.Patient Monsieur B quoted by Delpech'In the practice of occupational psychiatry one of the central problems is to relate toxic exposures to the development of psychological symptoms. We are even now unable to understand the psychopathological connections between "intoxication" and the phenomena of confusional states whereas for many occupational physicians "functional" disturbances of bodily function are virtually equivalent to deliberate malingering. Psychiatry has always been engaged in controversy to such an extent that historical arguments are forgotten and lessons once learnt must be relearnt.The quite opposing views of Delpech and Charcot that form the basis of this paper are expressed even now in discussions of the relative importance of "organic" and functional factors in the aetiology of occupational disease.Charcot is well known as one of the major figures in the development of neurology whereas Delpech is remembered, if at all, for his work on the adverse effects of carbon disulphide.

Neuropsychiatric Effects in Workers with Occupational Exposure to Carbon Disulfide

“…Workers with heavy CS 2 exposure, i.e. spinners in the spinning room had less years of education than workers with intermediate CS 2 exposure, and particularly than the non-exposed group. Highly exposed workers were more prevalent among those with less alcohol consumption, but also among those with most alcohol consumption.…”

“…Briefly, personal sampling of carbon disulfide was performed by means of passive diffusive charcoal badges on the second day of the morning shift. In the spinning rooms the TWA concentration was 57.7 mg of CS 2 Table 2). The average 2-thiothiazolidine-carboxylic acid (TTCA) readings in urine samples at the end of the day shift, as sensitive biological indicators of CS 2 exposure were significantly higher in spinners than in workers in viscose production (17.8 vs. 6.6 mg/g creatinine).…”

“…Instead, tiredness, sleepiness, affect lability, irritability, memory disturbances, decrease in intellectual capacity, as well as dizziness, headache and reduction in libido, are reported 3) . Psychological tests in workers exposed to long-term low levels of CS 2 have revealed different neurobehavioral changes, such as visual-perceptive, psychomotor or cognitive changes 4,5) . Despite progress in understanding the neurotoxicity of CS 2 exposure, some problems still exist.…”

“…Today, developed psychiatric signs and symptoms are rare as a result of changes in technology and improved working conditions 1,2) . Instead, tiredness, sleepiness, affect lability, irritability, memory disturbances, decrease in intellectual capacity, as well as dizziness, headache and reduction in libido, are reported 3) .…”