Breathing Space: A History of Asthma and the Environment

作者：Gregg A. Mitman（俄克拉荷马州大学）“呼吸空间：哮喘与环境的历史“在1982年至1994年之间，哮喘--美国儿童中主要的慢性疾病--的流行率增加了60%以上。哮喘的患病率在市中心的非洲裔美国儿童中不成比例地高于郊区的白色儿童，尽管研究表明这种差异更多地与社会经济地位和地点有关，而不是与种族或种族有关。虽然预防性保健服务不足被认为是造成这种发病模式的一个因素，但在过去的15年里，调查人员指出，除了室外空气污染物外，接触室内空气污染物（如烟草烟雾）和与尘螨和蟑螂有关的室内过敏原的增加是城市穷人哮喘症状发展和恶化的重要环境因素。在20世纪90年代，哮喘被认为是一种建筑环境疾病，一种生活在工业社会的慢性症状，环境污染物的风险在种族和社会经济界限之间分布不均匀。随着人们的注意力从历史上对“自然”环境的关注转移到城市和工业空间，建筑环境已经成为环境历史学家越来越感兴趣的主题。关于工业和城市发展的环境后果的历史奖学金大大提高了我们对工作场所和城市不断变化的环境条件如何塑造人类生活的经济，政治，社会和文化层面的理解。此外，学者们最近开始从历史的角度审视科学家和公民在建筑环境中与污染和环境危害作斗争的斗争，以及环境问题在整个世纪争取社会正义和平等的政治活动中所发挥的不可或缺的作用。尽管最近的工作，然而，尽管我们谈论环境，好像它抓住了一个单一的实体和利益的多样性，我们仍然很少欣赏如何概念和管理的环境的家庭，工作场所，和娱乐区在历史上是相互联系和分离的。通过一个地方的历史来观察哮喘--从强调环境控制和管理的治疗角度来看，从涉及从过敏原到空气污染的环境因素的病因学角度来看，从患者在山区度假胜地稀薄的空气中或最近通过家庭和工作场所的环境修复寻求更好的生活质量的角度来看，该项目调查了在过去120年里，对家庭、工作和娱乐场所的环境态度如何在医学、科学和流行的哮喘信念中相互作用。与霍乱、伤寒和肺结核等传染病不同，哮喘的治疗或治愈还没有灵丹妙药。尽管药理学的发展在治疗管理中发挥了重要作用，但在整个世纪晚期和二十世纪，哮喘患者的生活总是需要对哮喘患者生活、工作和娱乐的环境进行控制和管理。通过参与医生和其他护理人员规定的环境管理以及慢性患者在缓解哮喘方面的工作，该项目旨在阐明20世纪美国文化中环境与健康之间关系的历史变化。

SES 99-75526; Gregg A. Mitman (Univ. of Oklahoma) "Breathing Space: A History of Asthma and the Environment"Between 1982 and 1994, the prevalence of asthma -- the leading chronic illness among children in the United States -- increased over 60 percent. Asthma's prevalence is disproportionately higher among inner-city, African-American children than among suburban white children, although studies suggest that this disparity is linked more to socioeconomic status and place than to ethnicity or race. While inadequate access to preventive health care has been suggested as a contributive factor in this incidence pattern, in the last fifteen years investigators have pointed to increased exposure to indoor air pollutants such as tobacco smoke and to indoor allergens associated with dust mites and cockroaches in addition to outdoor air pollutants as important environmental factors in the development and worsening of asthma symptoms among the urban poor. In the l990s, asthma has become identified as a disease of the built environment, a chronic symptom of living in an industrial society, where the risks to environmental pollutants are distributed unequally across ethnic and socioeconomic lines.The built environment has become a subject of increasing interest to environmental historians as attention has shifted away from a historical focus on the "natural" environment to urban and industrial spaces. Historical scholarship on the environmental consequences of industrial and urban development has greatly enhanced our understanding of the ways in which changing environmental conditions of the workplace and the city have shaped the economic, political, social, and cultural dimensions of human lives. In addition, scholars have recently begun to historically examine the struggles of scientists and citizens to combat pollution and environmental hazards in the built environment and the integral role that environmental issues have played in political activism for social justice and equality throughout the twentieth century. Despite this recent work, however, and despite the fact that we speak of the environment as though it captures a single entity and diversity of interests, we still have little appreciation for how conceptions and management of the environment of the home, workplace, and recreational area have historically intersected with and diverged from one another.By looking at asthma through a history of place -- from a therapeutic perspective emphasizing environmental control and management, from an etiological perspective implicating environmental factors ranging from allergens to air pollution, and from the perspective of the patient seeking a better quality of life in the rarefied air of mountain resorts or more recently through environmental remediation of the home and workplace -- this project investigates how environmental attitudes toward places of home, work, and play have interacted in medical, scientific, and popular beliefs about asthma over the last 120 years. Unlike infectious diseases such as cholera, typhoid, and tuberculosis, no magic bullet has appeared for the treatment or cure of asthma. Although pharmacological developments have played an important part in therapeutic management, living with asthma has throughout the late-nineteenth and twentieth century always entailed the control and management of the environment, where asthmatics live, work, and play. By attending to the environmental management that physicians and other caretakers prescribed and that chronic sufferers employed in the alleviation of asthma, this project seeks to elucidate historically changing perceptions of the relationship between the environment and health in twentieth-century American culture.