Monday, May 2, 2016

Alice Hamilton, Occupational Health Pioneer

Alice Hamilton, 1883, the year she graduated medical school.
Schlessinger Library, Radcliff Institute, Harvard University
Dr. Alice Hamilton studied illness and disease and became the country's leading authority on occupational health. She identified over 70 different processes by which Americans were being poisoned by lead at work. 

Alice Hamilton was born in New York in 1869 and raised in Fort Wayne, Indiana. She grew up on a large estate as part of a privileged and wealthy family that had made its money by investing in railroads.

Alice was one of four sister, with one younger brother. Born within six years of each other, Alice would remain close with her sisters her entire life. All would pursue educations and professional goals and none would marry. In later life they would often travel and live together.

Alice, second from left, with her three sisters, Norah, Margaret, and Edith, 1880s
Schlesinger Library, Radcliff Institute, Harvard University
The girls received an education at home but it was unbalanced as they only learned what their parents thought was important, mainly languages and literature. In her teenage years Alice decided to become a doctor.

As she explained in her autobiography, “I chose medicine not because I was scientifically-minded, for I was deeply ignorant of science. I chose it because as a doctor I could go anywhere I pleased — to far-off lands or to city slums — and be quite sure I could be of use anywhere.” To overcome her lack of scientific knowledge, Alice attended classes in physics, chemistry, biology, and anatomy, and thusly prepared, enrolled in the medical department at the University of Michigan in 1892.

The university was one of the leading medical schools of its day, and Alice's first experience away from home. "I loved it," she would later report. After completing her degree she sailed to Germany with her sister Edith to take classes in bacteriology and pathology, areas that would become her specialty, but German universities did not admit women.

The sisters were eventually allowed admittance to classes in Munich and Leipzig on the condition that they remain "invisible" to the male students. Following her studies in Germany, Alice returned to the United States in 1896.


There was not much demand for a trained pathologist or bacteriologist in the United States at that time, so Alice worked for a year at Johns Hopkins University in Baltimore, then began teaching pathology at the Women's Medical School of Northern University in Chicago.

Alice took the teaching position not only for the job, but because it provided the chance to live at Hull-House, one of the most famous settlement houses in the United States. The house was founded by Jane Adams and Ellen Gates Starr, and was one of a series of such houses set up in poor neighborhoods across the north.

Settlement houses had originated in London in 1884 and the idea spread quickly to the United States, with over 400 establishments by 1910. Women led most of the settlements in America, and they were funded by donations, and residents paid for room and board. Settlements tended to be located in big cities with diverse immigrant populations.

As seen by the women who established them, the purposes of the settlement houses were twofold: to provide social services and education to those in poverty to try to alleviate some of their misery and help drive reform, and to provide those in the upper and middle classes with an insight into "the real world" of poverty, as relayed by the residents.

The residents of Hull-House were constantly exposed to disease and suffering in their neighborhoods. Of the surrounding conditions, Jane Adams would write in her book, Twenty Years at Hull-House, “The streets are inexpressibly dirty, the number of schools inadequate, sanitary legislation unenforced, the street lighting bad, the paving miserable and altogether lacking in the alleys and smaller streets, and the stables beyond description. Hundreds of houses are unconnected with the street sewer.”

Hull-House would offer many community programs and facilities that had never before been available in Chicago. They had the first public baths, first public playground, first public kitchen, first public gymnasium. In addition to this they offered the first college extension courses, and in fitting with their belief that culture and beauty should be available to everyone, the first little theater in the United States.

Besides facilities, they also offered a kindergarten, nursery, music school, art gallery, and legal and medical services. Classes were available in English and citizenship, and an Immigrants' Protective League was created to help immigrants with legal challenges. The house also supported labor unions at a time when many upper and middle class organizations opposed them.

From the perspective of the women working there, Hull-House provided ample opportunity to learn more about poverty-stricken neighborhoods. Investigations were conducted regarding income, school truancy, sanitation, tuberculosis, cocaine distribution, infant mortality, and other issues affecting the safety and health of the neighborhood.

Alice Hamilton had a day job teaching at the University, but in the evenings and on weekends she devoted her time to Hull-House. She opened a well-baby clinic to provide baths for children and offer advice to mothers about diet and avoiding contagious diseases, and it soon expanded to treat children from birth to eight years old.

In her autobiography Exploring the Dangerous Trades (1943), Alice would later write the following of her time at Hull-House: “Life in a settlement does several things to you. Among others, it teaches you that education and culture have little to do with real wisdom, the wisdom that comes from life experiences.”

Industrial Toxicology

Working at Hull-House, Alice often found herself treating residents for diseases resulting from their working conditions. From her autobiography: "Living in a working-class quarter, coming in contact with laborers and their wives, I could not fail to hear tales of dangers that workingmen faced, of cases of carbon-monoxide gassing in the great steel mills, of painters disabled by palsy, of pneumonia and rheumatism among the men in the stockyards.”

It was in 1910 that Alice got the opportunity to delve into these matters more thoroughly. Due to her experience and education in pathology, Alice was appointed head of a commission to investigate industrial illness in Illinois. The mortality rate associated with certain industries were high, particularly among the enamelware industry, rubber production, painting trades, and explosives and munitions, so the committee members set out to discover more about why.

Alice would take on the study of lead industries for the survey. Little was known about industrial toxicology at that time, so Alice and the members of the commission had to devise the methodology and choose which industries to investigate on their own. The report would focus on lead, arsenic, zinc smelting, brass manufacturing, turpentine, and carbon monoxide.

To gather their evidence, the team visited factories, read hospital records, and interviewed labor leaders and pharmacologists. During her visits, Alice uncovered 70 different industrial processes by which workers were being exposed to lead poisoning. Besides some of the practices they were already aware being associated with lead poisoning, she found less obvious ones, such as polishing cut glass and wrapping cigars in "tinfoil" that was actually made of lead.

In one instance she visited a factory that applied the enamel coating to bathtubs, and the owners assured her that no lead was involved in the process. The managers of the facility let Alice inspect the workplace and she found no trace of lead, which puzzled her greatly as she had spoken with a worker there who was certainly suffering from lead poisoning. Interviewing him further, she found that she had only investigated the workshop where the final stages of enameling took place, and that most of it occurred at another location.

At the primary location of the enameling, a fine powdered enamel was distributed by a worker sprinkling it over a molten-hot tub, where it would melt and flow over the surface. When she tested a sample of the powder they were sprinkling, Alice found it was nearly 20% lead.

In this manner, Alice was able to decisively pinpoint which processes and industries in the state were dangerous when it came to lead exposure.

The Report

The commission's report provided the evidence the medical community and government needed to make a direct link between occupation and illness. In 1911 Illinois passed an occupational disease law that required employers to implement safety procedures that would limit their workers' contact with dangerous substances, to provide monthly examinations to workers in dangerous trades, and to report any incidents of illness to the Department of Factory Inspection.

These finding and the resulting regulations were the first of their kind, and caught the attention of Charles Neill, the Commissioner of Labor in the U. S. Department of Commerce. He asked Alice to create the same report again, but this time nationally, starting with the lead trade, then expand it to other hazardous occupations.

If she agreed, Alice's work would not be funded by the government and she would have little support logistically so she was essentially on her own, except for the promise that the government would buy her final report when it was done.

She described this further in her autobiography: “I had, as a Federal agent, no right to enter any establishment — that must depend on the courtesy of the employer. I must discover for myself where the plants were, and the method of investigation to be followed. The time devoted to each survey, that and all else, was left to my discretion. Nobody would keep tabs on me, I should not even receive a salary; only when the report was ready for publication would the government buy it from me at a price to be decided on.”

By this time, Alice was in her early forties, and was the leading expert on lead poisoning in the United States, part of a very small group in the developing field of occupational diseases. She accepted the offer to take on the study, and "never went back to the laboratory."

Studying lead across the nation

Alice tackled the work for the federal government the way she had tackled the initial report for Illinois: by carefully and thoroughly examining local hospital records for reported illnesses, then inspecting factories to determine which processes exposed workers to dangerous chemicals.

In different states she identified new processes that were exposing workers to lead. For example, in her investigation of white lead, commonly used in the paint industry, the toxic substance was being inhaled when workers breathed in air laden with lead dust and fumes.

As no methodology for such investigations existed prior to Alice's own, she was careful to impose a strict standard for herself, to ensure the results were legitimate.

No matter how the lead was ingested, Alice's determination of lead poisoning was the same: “I would not accept a case as positive,” she wrote, “unless there was a clear ‘lead line’… a deposit of black lead sulfide in the cells of the lining of the mouth, usually clearest on the gum along the margin of the front teeth.”

Seeing these cases with her own eyes and understanding the source of them made it impossible for Alice to simply record the information without saying anything. Armed with her reports, Alice would approach facility supervisors and tell them how many cases of lead poisoning she had found on the premises, and encourage them to do something about it.

One might not think this would have a good outcome, but Alice was rewarded on occasion by seeing her words take effect. When she confronted Edward Cornish of the National Lead Company, for instance, he was initially "indignant and incredulous," but when she revealed the 22 cases she had recorded among his workers of severe lead poisoning, he did not argue. In light of Alice's information Cornish made changes to his processes, introducing dust and fume prevention methods that had never been used prior.

A growing field

In 1919 when Harvard Medical school began offering a program in industrial hygiene, they asked Alice to join as an assistant professor of medicine. As Harvard was not admitting women at that time, she would be the first women professor or student to be admitted.

Not that we can give Harvard too much credit for opening their collective minds on this position, however, as it came with stipulations: Alice could not attend the Faculty Club; she could not get football tickets; and she could not attend graduation. Alice accepted, but gave her own terms: she would only teach for one semester a year, so she could spend the rest of her time at Hull-House.

Alice remained an assistant professor until forced to take mandatory retirement at 65, at which point she moved with her sister Margaret to Hadlyme, Connecticut.

During WWI and in the years following, Alice continued to study the various toxins that could be found in American factories. In wartime there was an increased need for explosives, TNT, picric acid, mercury fulminate, and other substances. Her investigations and reports on the hazards of handling such materials led to the implementation of many new safety procedures.

Even after her retirement in 1935, Alice continued to study the chemicals used in the manufacture of viscous rayon. This was a new industry and it used carbon disulphide and hydrogen sulphide, both chemicals that could wreck havoc on an invidual's mental and physical capacities. Alice had reported on carbon disulphide as early as 1914 when she analyzed the process for making rubber, but in the 1930s it surfaced again, this time tied to serious illnesses being reported by viscous rayon workers.

She convinced the Department of Labor to investigate, and put her in charge of the study. Her results would be published in Occupational Poisoning in the Viscose Rayon Industry. Alice had once again made an industry safer for thousands of American workers, but it would be her last investigation.

Active to the end, in her eighties and nineties Alice was an active voice in the community and campaigned against McCarthyism, and what she considered to be an overzealous amount of anti-communism. In 1963, at the age of ninety-four, she signed an open letter to President Kennedy asking for early withdrawal of U.S. troops from Vietnam.

Her lack of fear and encouragement of others to express their views made her a target of the FBI during this time, and they monitored her activity (I doubt she cared).

Alice Hamilton celebrated her 100th birthday in 1969, and died at 101 on September 22nd, 1970. She saved and improved countless lives with her dedication to identifying occupational hazards and created an entirely new field of study.


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