Alice Hamilton: Crusader and Scientist

Appreciation
Published in the 2014 September Special Supplement Synergist

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Alice Hamilton

Initially trained as a physician, Alice Hamilton was the foremost practitioner of industrial toxicology in the early part of the 20th century. Her main area of research was on industrial hazards, most notably lead, and although she never held a position of leadership in AIHA, her work exerted a profound influence on the association’s earliest members. Beginning with the report she prepared for the Illinois Commission on Industrial Diseases in 1910, which represents the first time hospital records were used extensively to correlate medically diagnosed diseases with specific occupations, Hamilton was a passionate proponent of worker health. Her investigations of working conditions in various industries and the persuasive way she presented her findings to initially incredulous company managers continue to serve as models for today’s industrial hygienists.

Throughout her long, unusually productive life—she continued publishing articles into her nineties, and died at the age of 101—Hamilton was a pioneer in more than her profession. In 1919 she became the first woman to serve on the faculty of Harvard University, whose School of Medicine was organizing the first degree program in industrial hygiene. She was a prominent pacifist, supporter of birth control, and advocate for social legislation, including unemployment compensation and national health insurance. She was also a key contributor to the Settlement movement and spent 22 years living at Jane Addams’ Hull House in Chicago.

Barbara Sicherman, a historian whose book Alice Hamilton: A Life in Letters combines biography with selections from Hamilton’s personal and professional letters, graciously agreed to share her perspectives on Hamilton with The Synergist. An edited transcript of this discussion is on the following pages; the full interview is available as a podcast from http://bit.ly/hamiltonpodcast.

Q. What effect did Jane Addams and Hull House have on Hamilton?

A. Well, it was really incalculable. Meeting Addams and living at Hull House were fundamental in reshaping Hamilton’s values and career. It’s also fair to say that she went there looking. While still in boarding school she not so facetiously announced her future address as “corner of 375th Street and slum alley.” Settlements were private neighborhood centers established in poor urban areas by privileged men and women who hoped to bridge the growing gulf between classes. In contrast to Britain, American settlements were often led by women. Hull House was the most famous of these, and Jane Addams, a charismatic woman who became the foremost woman leader of her day, was the cofounder.

The core settlement ideal, articulated most fully by Addams, was that people of privilege could and should find ways of bringing aid and comfort to the underprivileged men and women of the working class, many of them immigrants, by living among them. The nearest comparison today, I suppose, would be the Peace Corps. Hull House residents, many of them recent college graduates, began by doing things like setting up day nurseries and kindergartens, leading clubs, offering classes, but the settlement soon became a hotbed of reform as residents came to understand the environmental causes of poverty.

After thorough investigations of sweatshops, the substandard housing, and child labor, they proposed and sometimes attained legislative remedies and/or administrative oversight. Hamilton had a full-time job, but every resident had duties, and she initially managed a well-baby clinic. But she was more engaged by her investigations of neighborhood health conditions, typhoid, the cocaine traffic, and occupational diseases. Hull House was already a factor in state politics, so it is not surprising that a reform governor appointed her to the Illinois Commission on Industrial Diseases in 1910. The rest is history.

Q. Hamilton is considered a pioneer in industrial hygiene, but she didn’t think of herself as an industrial hygienist. What did her work entail?

A. I would say that industrial hygiene as a field had not fully taken shape when she began her work, nor had its sister specialties been organized. Her first step was to establish the prevalence of poisons in Illinois industries, about which little was known, a task complicated by secrecy on the part of manufacturers. Lacking authority to enter plants, she relied on shoe-leather epidemiology, picking up leads about ailing workers by talking to physicians, druggists, and especially to workers whose homes she often visited in the Hull House manner. In this way, Hamilton and her coworkers documented nearly 580 cases of lead poisoning and established that some 70 industrial processes in the state used lead.

The study had real impact. Illinois passed an occupational disease law the following year. Hamilton went on to conduct important industry-by-industry studies of lead for the U.S. Bureau of Labor, among them the white-lead, pottery, painting, and storage battery industries. These early studies correlated specific industrial processes with medically diagnosed cases of lead poisoning. Hamilton adopted strict standards for reporting, but her surveys demonstrated beyond a doubt that American factories had high morbidity and mortality rates.

Her studies were so impressive that when David Edsall, dean of Harvard’s Medical School, was asked to justify Hamilton’s precedent-making appointment to a new degree program in industrial hygiene in 1919, he reassured Harvard’s president that “She is greatly superior to any man that we can learn of for the position.” She was also probably the only person who was doing it pretty steadily. From the start, Hamilton made it a point to go beyond what she called the “cold printed report.” In the absence of government authority to enforce change, she took her findings directly to those in charge and asked them to act voluntarily on her recommendations. Many did. She also believed that they took advice from a woman more readily than from a man.

During the Harvard years, Hamilton established herself as the leading authority on industrial poisons and waged an insistent campaign to publicize industrial diseases among professionals and the public. She was, in the words of Yale Professor C.-E. A. Winslow, a leading public health specialist, the unusual combination of “crusader and scientist.” On the one hand, she had an unsurpassed command of industrial poisons in Europe as well as the U.S. and codified knowledge in two textbooks, one for specialists, one for general physicians. On the other, she took a broad view of her professional responsibilities and maintained constant vigilance over the field as clearinghouse, troubleshooter, and watchdog.

She responded to requests from all over the country about unusual outbreaks in factories and worked with all interested parties, ranging from the business-affiliated National Safety Council to the union-based Workers’ Health Bureau. Where many of her medical colleagues were dubious about airing scientific questions in public, she mobilized support for a national conference on radium poisoning called by the surgeon general in 1928. This was in response to the famous case of the New Jersey watch dial painters who contracted radium poisoning.

After retiring from Harvard in 1935, she served for some years as the medical consultant for the new Division of Labor Standards in the Department of Labor. She also did her final study, this one on viscose rayon. Looking back in old age at changes in the field, she felt satisfied “that things were better now and I had some part in it.” She died at the age of 101 in 1970, just three months before passage of the Occupational Safety and Health Act.

Q. Her appointment at Harvard was part-time, as you said, which freed her to conduct investigations of factories on her own time. What did the management and executives at these companies think of her?

A. Surviving letters suggest that some manufacturers at least found her evidence persuasive and disturbing and tried to implement changes that she recommended, including such things as improved ventilation, respirators, weekly medical examinations, and the like. She remained on cordial terms with a number of owners and corresponded with them for many years. These connections proved invaluable.

It was through Hamilton’s initiative in the 1920s that the presidents of several lead companies funded a Harvard study of the lead industry with no strings attached. The landmark research that resulted established how lead was absorbed, stored, and eliminated from the body and developed an effective treatment for lead colic, so it was really quite an astounding study for the time.

Q. Why is Alice Hamilton still revered today?

A. Pioneers are often honored and deservedly so. Hamilton was one of the first Americans to investigate workplace poisons at a time when little was known about them and less was being done. Her early studies provided new facts that helped to undermine American complacency. More than that, Hamilton was the only person who made the control of industrial poisons her life’s work. In the absence of formal institutions and regulations, she took it on herself to find individual and collective ways of preventing and controlling industrial diseases. As a 1934 editorial in the Detroit Medical News proclaimed, “The name ‘Hamilton’ parallels the building up of the awareness and the study of poisoning in industry.”

Finally, I think that people find it intriguing that a woman, especially one viewed as “very feminine and even fragile,” as some considered her, achieved so much in a line of work once considered very masculine. Perhaps this is why she has been mythologized to the point of receiving credit for achievements she never made, such as the elimination of phossy jaw. My hope as her biographer has been to uncover the human person behind the myth and to demonstrate that even legendary careers develop incrementally.


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