SYMHC Classics: Alice Hamilton and Occupational Medicine

This 2019 episode covers a trailblazer in science and medicine. Hamilton dedicated her life to improving the workplace standards for laborers in an effort to reduce illnesses that came from working with toxic chemicals.

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Episode Transcript

Speaker 1 (00:02):
Happy Saturday. Dr Alice Hamilton's is going to come up
in one of our forthcoming episodes, along with her groundbreaking
work in the field of occupational medicine, specifically the dangers
of workplace and environmental exposures to lead. So we are
bringing our episode on her out as Today's Saturday Classic.
This originally came out on May six, so enjoy. Welcome

(00:28):
to Stuff You Missed in History Class, a production of
I Heart Radio. Hello, and welcome to the podcast. I'm
Holly Fry and I'm Tracy be Wilson and Tracy. Today's
episode is going to delve into the start of the
study of occupational disease and the woman behind that beginning.

(00:49):
That's an important field, it is, and it's one of
those interesting things that we see is so important today
but a hundred years ago not so much. Well. Occupational
health has also been affecting people for much, much, much
longer than it has existed as a field. Like yes,
and it is one of those things that even while
I was researching this episode, I found myself going, why

(01:11):
why didn't anybody study this? There's pretty obvious cause and
effect for some of this stuff. One, yeah, but a
number of previous episode topics are going to get mentioned
as we uh go through this story. Yes, uh so.
Dr Alice Hamilton's was a trailblazer in science and medicine
and she dedicated her life to improving the workplace standards

(01:34):
for laborers in an effort to reduce illnesses that came
ardly from working with toxic chemicals. And this episode was
requested by our listener Emily, who actually sent us a
book to kickstart research, which is very kind and it's
actually a really fun book, So thank you, Emily. So
on February sixty nine. Alice Hamilton's was born in New

(01:54):
York City. Her parents were Montgomery Hamilton's and Gertrude Pond.
The family had really strong roots in Fort Wayne, Indiana.
That was where her grandfather had been a land speculator
and entrepreneur after immigrating from Ireland to the United States,
and he had bought and sold a lot of property
in Fort Wayne. Yeah, I read one account that basically said,

(02:15):
like almost any piece of property you stand on in
Fort Wayne today at some point passed through his hands
in terms of ownership. Alice was born in New York
because her mother, Gertrude, had wanted to go to have
the baby at her family home, which was in New York,
but when Alice was still very very tiny, she and
her mother went back home to Fort Wayne to live
on the property that they had there, which is a

(02:35):
family called Old House. And the Old House itself had
been built in eighteen forty, and Alice once described it
as having been built quote for beauty, space, dignity, not
for comfort and convenience. The family had staff, and so
that inconvenience was borne by them, but Alice was very
aware of the inherent wastefulness in building rooms so large

(02:57):
that there had to be someone constantly tending to the
fire errs, and having so many stories before running water
that maids had to continually be carting water up flights
of stairs. Montgomery, Gertrude and the children didn't live in
Old House, although they spent a lot of their time there.
They had a slightly smaller home on the same property
called White House, and a home called Red House was

(03:20):
where Alice's uncle lived. The one thing that Alice saw
is a great benefit in those overly large homes was
the ability to find some quiet space to be alone
and get away from the bustle of a very large family.
Alice and her sisters Edith, Margaret, and Norah, and her
one baby brother, Arthur, who came along a little later,
were home schooled by their parents. Gertrude Pond Hamilton's thought

(03:43):
that the hours of public schools were unreasonable, and her father, Montgomery,
thought that the subjects that they taught at those schools
were far too boring for his children. Uh Edith incidentally
went on to become a well known author and classicists,
you mean recognize the name of Hamilton's and the sisters
had all been born pretty closely, within six years of
each other, and they were very very close to one another.

(04:05):
Their brother, Arthur, who went by quint, was born much later,
when Alice was seventeen. Alice described this upbringing, being taught
at home and not really having friends outside of their family,
as one that turned them all into bookworms eventually. Quote
and since we saw so little of any children outside
our own family, the people we met in books became

(04:26):
real to us. But to be clear, there were other
children around. Eleven cousins lived on the property where old
house and the other home set, so sort of a
giant family compound, kind of yes, uh, And it wasn't
until Alice was a teenager of seventeen that she received
any formal education when she attended Miss Porter's School in Farmington, Connecticut.

(04:51):
And that was and still is a private preparatory school
in Connecticut, and Alice's time there was the prelude to
entering the University of Michigan Medical School. Alice thought that
the school was awful, and she selected courses that would
either be fairly easy. She already had a lot of
linguistics education from her parents, so she took a lot
of that, or she picked courses for which she could

(05:12):
just memorize the needed information without really digesting and understanding it.
But that meant that when she decided to go into medicine,
she was woefully lacking. She needed to take extra classes
to get properly prepared for it. She had to take physics, chemistry, biology,
and anatomy courses after she finished at Miss Porter's. Once
those were complete, she enrolled at the University of Michigan.

(05:36):
Even though this was decades after Elizabeth Blackwell became the
first woman to graduate for medical school in the United States,
it was still pretty unusual for a woman to pursue
a career as a physician, but it turned out that
Alice really loved both the freedom and the challenge of
being on her own and learning so much about clinical
and lab work. Eventually, she decided she wanted to do

(05:58):
research instead of practice me uson and when she finished
medical school in eight she worked as an intern in Minneapolis, Minnesota,
at the Hospital for Women and Children, and after two
months there, she moved to her next training position, this
time at the New England Hospital for Women and Children,
which is located near Boston. Her education continued after that.

(06:19):
She studied in Leipzig and Munich over the course of
a year. Because Germany was really where her chosen fields
of bacteriology and pathology were most advanced. This was a
tricky thing for her to negotiate because German schools were
not open to women at that time. Alice and her
sister Edith, who traveled to Germany with her, had to
promise that they would be invisible to the male students.

(06:43):
After gaining a solid level of knowledge in Europe, Alice
came back to the United States to attend Johns Hopkins
University for a year. Once all of that schooling was done,
Hamilton made the switch in roles from student to educator,
and she began teaching at the Northwestern Universities Women's Metal
Cool School. In addition to her teaching, she also joined

(07:04):
Chicago's Hull House and moved in there. That is the
settlement house founded by Jane Adams that we discussed in
our episode about Adams. Alice Hamilton has actually mentioned very
briefly in that episode, and as part of her life
at Hull House, Alice founded a well baby clinic for
the community, and she also made the connection between typhoid
spread and poor sewage disposal during the nineteen two epidemic

(07:26):
in Chicago. Hull House made a big impact on Alice,
and her ongoing work there really shaped her worldview. She
once famously said of it quote, 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 experiences. And it was during

(07:47):
this work at Hull House and offering medical treatment and
assistance to the poor families in the community, that Alice
started to see firsthand just how closely linked disease was
to poverty, and she started to realized just how dangerous
working conditions were for the poor, who were often immigrants
with little power to improve their workplaces or to move
into less hazardous careers. In she wrote her first paper

(08:12):
on the subject of occupational disease, and her works importance
and her level of knowledge on the topic, we're pretty
quickly acknowledged this is the time when workers in the
United States were routinely handling toxic substances with little to
no protection. We have talked on the podcast before about
things like fossy jaw and mercury poisoning, and those were
not uncommon among poor laborers, but in the United States

(08:35):
there really wasn't any formal work being done to study
these kinds of issues in the workplace. And we're going
to talk about the next stage in Hamilton's career, which
came because of the recognition that she achieved for that
early work in studying occupational disease. But first we'll pause
and have a little of sponsor break. In Alice Hamilton's

(09:04):
was appointed to lead an Occupational Disease Commission which was
formed by Illinois Governor Charles Deneen, and that commission was
established to study industrial disease. It was the first of
its kind in the United States, Lead, arsenic, carbon monoxide, brass, cyanides,
and turpentine were all to be studied over the course

(09:24):
of a year per the Governor's office, and Hamilton's, in
addition to being the leader of this initiative, focused on
lead in particular, and so she started researching the connection
between industry and disease, pioneering the field of occupational epidemiology.
She later wrote quote, it was while I was living
in Hull House and working in bacteriological research that the

(09:46):
opportunity came to me to investigate the dangerous trades of Illinois,
not those where violent accidents occurred, but those with the
less spectacular hazard of sickness from some industrial poison. It
was a voyage of explor ration that we undertook our
little group of physicians and student assistants, for nobody in
Illinois knew even then where we should make our investigation

(10:08):
beyond a few notorious led trades. American medical authorities had
never taken industrial diseases seriously. The American Medical Associations had
never held a meeting on the subject, and while European
journals were full of articles on industrial poisoning, the number
published in American medical journals up to nineteen ten could

(10:28):
be counted on one's fingers, and the work on this
project was extensive. Dr Hamilton's and her team spoke with
laborers and pharmacists about factory conditions and instances of lead poisoning.
They also reviewed medical records and hospitals, and they went
to factories to see for themselves what the conditions were like. And,

(10:48):
as you might suspect, this line of investigation was not
exactly welcomed by some of the people in power in
the industries that she wanted to research. In her autobiography,
she describes some of the attitudes about illness and injury
that she encountered. Quote, as I look back, some striking
pictures come to me of that anarchic period. One is

(11:09):
the picture of the works manager of a big white
lead plant, a gentleman of breeding and something of a philanthropist.
He is looking at me indignantly and exclaiming, why that
sounds as if you think that when a man gets
lead poisoning in my plant, I ought to be held responsible.
Another is that of a Hungarian woman at Hull House
telling me of a terrible accident and a steel mill

(11:32):
on the South Shore in which her husband had been injured.
He and the other victims were being held in communicado
and the company hospital. No one was allowed to see them.
She knew nothing except that her husband was not dead. Yeah,
she has a lot of accounts. If you read her autobiography,
there are many similar stories that she witnessed. A lot

(11:52):
of Hamilton's writing on the issues she was researching at
this time mentions the various people who were ignorant and
indifferent in allowing danger of circumstances to continue to be
the norm in factories, from the owners to the foreman,
to the company doctors, and even the workers. She wrote quote,
the employers could, if they wished, shut their eyes to
the dangers their workmen faced, for nobody held them responsible,

(12:15):
while the workers accepted the risks with fatalistic submissiveness as
part of the price one must pay for being poor.
She also cataloged the various excuses she was given by
employers and her investigations about illness and disease among their workers.
Some took racist positions, claiming that the various immigrant groups
were filthy and never washed. Others claimed that various illnesses

(12:39):
weren't the result of anything related to their work, but
were caused by alcoholism among the employees. She wrote, quote,
there is no form of industrial poisoning which I have
not heard some man attribute to whiskey. Even though Hamilton's
and her colleagues had been appointed to a commission by
the governor, they didn't have any actual authority to just
walk into ants and start asking questions. And there was

(13:02):
also no real set of guidelines or procedure for how
they should do this work. So they simply started looking
for themselves for places that would fall under the umbrella
of their mandate, and then they would just ask to
enter and look around and speak with someone in authority.
And Alice does mention in her writing that she was
always greeted with kindness, and then in some cases foreman

(13:23):
or factory owners already had their own worries about employee health,
and they were actually really glad to have someone helping
them figure out the problem. This commission wasn't intended to
be a whistleblowing operation, though Alice wasn't supposed to identify
any of the factories and her reports by name or
give details that could identify them, and she submitted the

(13:44):
reports in the manner that was requested. She wasn't completely
comfortable with that, though. She worried that people weren't being
helped in a direct way while government agencies reviewed the
findings of the report. So she started a habit of
telling the men in charge of the factories where she
found concern exactly what she felt was wrong. She gave
these men her own recommendations for the simple steps they

(14:05):
might take to improve conditions, and later she wrote about
how surprised she was that this informal quote primitive method
actually worked. In one case, she had visited a white
lead works that was open with the intent of being safe,
but then there hadn't been a protocol in place to
remove waste materials from production, and there were piles of

(14:26):
it around the factory, and she spoke to the manager,
but he was not very enthused about being told what
to do. The plant owner wasn't really an option. He
was elderly and not really actively involved in running the factory.
But then she remembered that she actually knew the owner's daughter.
The two women had gone to school together, and so
by reaching out through that channel, Alice was able to

(14:47):
explain to her former schoolmate problems going on in the
lead works and encourage a little bit of change, and
that worked. The factory not only changed its operating procedures
to include removal of the waste products on a regular basis.
Leadership actually asked Alice to stop by periodically and inspect
things for them and just touch base. And she continued

(15:08):
to develop relationships both through these kinds of ways and
with managers and foremen as often as possible so that
she could keep their discussions about safety cordial. And she
continued to leverage any other means she could to enact
change in ways that her government work couldn't really do. Ultimately,
though the report that Alice compiled with her colleagues did

(15:29):
have significant impact. It made a clear case showing that
illnesses were often the result of on the job conditions.
In nineteen eleven, the state of Illinois pass legislation that
required three things of employers. One they had to follow
new safety guidelines to minimize the risk of occupational disease. Two,
if they employed workers in so called dangerous trades, they

(15:51):
had to provide monthly health screening for those employees. And three,
they had to report any illnesses to the Department of
Factory inspection. In nineteen eleven, after her work with the
State of Illinois Commission concluded, Alice Hamilton was asked to
serve as a special investigator for the Federal Department of
Labor Bureau of Labor Statistics because of the reputation she

(16:11):
had earned for her work at the state level, and
she served in that role for almost a decade and
continued her study and investigation of lead in industry, as
well as rubber, viscoast, rayon, and other substances. Hamilton's continued
to break barriers in her career, and we will get
to another of those right after we pause for one
of the sponsors that keeps us going. During World War One,

(16:41):
Hamilton's turned her attentions to the industries associated with war
for investigation. She studied factories where munitions were made, and
she submitted reports outlining the dangers of the various chemicals
involved and how those dangers might be addressed for worker safety.
Many safety procedures were established because of the work she
did during those years. She also commented at one point

(17:03):
that she felt like because the government was so quick
to act on those recommendations, it kind of gave her
work a level of credibility that it hadn't really had before.
Nearing the end of her work in the Bureau of
Labor Statistics, Hamilton's was offered a position teaching at Harvard
Medical School as an assistant professor of Industrial Medicine. That
made her the first woman on the faculty there, and

(17:24):
there's some irony in that appointment. The school wasn't accepting
women as students at the time. When she was interviewed
on the subject, Alice Hamilton was always quick to point
out that she shouldn't have been the first woman on
the faculty and she was I was like, yes, I
am uh. We should have been doing this before. Uh.

(17:44):
And despite the attention that her groundbreaking position gained the school,
she was denied a number of benefits that were available
to other faculty members. For example, she wasn't allowed into
the faculty club, and she wasn't allowed to participate in
the commencement procession, and she would not receive any football tickets.
Those were all benefits that any other faculty member would

(18:04):
have had. But as part of her hiring negotiation, Dr
Hamilton's wanted to teach only one semester each year, and
that way the remainder of the year would be spent
on her work at Hull House and on her ongoing
research into toxicology. Alice was appointed to the League of
Nations Health Committee that made her the only woman chosen

(18:24):
for it. That same year, she was invited to the
Soviet Union to offer her expertise on the management and
treatment of occupational disease. There, Hamilton's continued to use her
various positions to work not just for the betterment of
occupational health, but also for social reform and healthcare. Her
work with impoverished communities continued to drive her efforts, including

(18:46):
work in epidemic disease, infant mortality reduction, and addiction, and
she also advocated for family planning at a time when
that was not a very welcome topic because she saw
how much women in impoverished communities really didn't have education
on the matter, and also in some cases their health
was put at risk by having pregnancy after pregnancy, after pregnancy.

(19:07):
She also worked in the interest of women's labor rights,
even when that position stood in opposition to legislation that
was introduced for equal rights. Hamilton was concerned that the
wording of bills introduced for equality in the workplace would
diminish protections for women in the workplace, so she became
an advocate for women in labor industries like textile mills,
food packaging and processing plants, as well as hospitality. In

(19:31):
nineteen fifty two, she became an advocate for the Equal
Rights Amendment once she felt that equality legislation wouldn't diminish
protections for women at work, and part of the reason
she was so adamant about those protections was that she
had collected data that showed that there were ways in
which women were more vulnerable than men when it came
to certain issues of industrial poisoning. Her research indicated that

(19:53):
women were more susceptible, particularly to lead poisoning, and all
industrial poisonings had the added complication of potentially causing birth
defects and or sterility. In she wrote the first text
on toxicology, titled Industrial Poisons in the United States. Nine
years later, in nineteen thirty four, she wrote another text book,

(20:14):
Industrial Toxicology. The year after Industrial Toxicology was first published,
Hamilton's time at Harvard ended because she reached mandatory retirement
age in the sixteen years that she was there. She
was never promoted beyond the title of assistant professor, and
instead had been employed on a series of three year
contracts that renewed over and over. After leaving Harvard, Hamilton's,

(20:35):
who was sixty six at the time, hadn't actually retired
from her life's work. She moved to Haadline, Connecticut with
her sister Margaret, who, like all four of the Hamilton's sisters,
had not married, and Alice continued to consult on the
topic of toxicology in industrial settings, including acting as an
advisor to New York State Industrial Commissioner Francis Perkins. Even

(20:57):
outside of consulting, Dr Hamilton's stayed busy. In nineteen forty three,
she wrote her autobiography, Exploring the Dangerous Trades. She revised
her textbook Industrial Toxicology in nineteen forty nine when she
was eighty and as Joseph McCarthy stirred up the Second
Red Scare in the u s and the late forties
and early fifties, she spoke out against it. At that
point she was in her eighties. That activism continued into

(21:20):
her nineties, when she wrote to President Kennedy to urge
him to get American troops out of Vietnam. On February
nineteen sixty nine. Hamilton's celebrated her one birthday the following year.
She died on September twenty, nineteen seventy, after having a stroke.
Three months after her death, on December nineteen seventy, the

(21:40):
Occupational Safety and Health Act of nineteen seventy became law.
It's opening paragraph reads, an Act to assure safe and
healthful working conditions for working men and women, by authorizing
enforcement of the standards developed into the Act, by assisting
and encouraging the States and their efforts to assure safe
and healthiple working conditions, by providing for research, information, education,

(22:04):
and training in the field of occupational safety and health,
and for other purposes. Yes, so that was kind of
the culmination of her life's work, and she just missed
seeing it happened by a few months. Today, the Centers
for Disease Control and Prevention give out the Alice B.
Hamilton's Awards for Occupational Safety and Health, and on her
birthday in ven the National Institute for Occupational Safety and

(22:26):
Health Ridge Avenue Facility in Cincinnati, Ohio was dedicated to
her memory and named the Alice Hamilton's Laboratory. For Occupational
Safety and Health. In two thousand to the American Chemical
Society designated Alice Hamilton's and her work in industrial medicine
a National Historic Chemical Landmark. And to close, I wanted
to offer up a fairly famous quote from Dr Allis

(22:49):
Hamilton's autobiography, and it reads, quote 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, too far off lands or
to city slums, and be quite sure I could be
of use anywhere. That's such a great sentiment, it is,

(23:09):
And it's like her heaps me too. Uh. One of
the things that I think is really interesting about her
story is that it's sort of it shows how when
there's progress in some field, it's not like there's a
switch that gets flipped where everything is fixed now, like
the Radium girls were after this, and like I think
she was part of some of the investigation of that,

(23:32):
and like that was well after Illinois had passed laws
related to this. Like it's it's an example of sort
of the trajectory of things that that take a while.
And of course there are plenty of occupational issues that
still exists today. Yeah. In her autobiography, which we mentioned
was written in the forties, there's a funny moment where

(23:53):
she talks about how like to her, it's almost amusing
that people started using like the the safety first wording,
when she's like, when I started doing this, that would
have been like an athema. Nobody would have said those words.
So she was seeing the progress and could appreciate her
impact even if she did not get to see that
the OSHA law UM finally signed into reality. That law

(24:16):
is older than I thought it was. Yeah. Yeah, And
it's one of those things I think people don't always know,
like the origin point for OSHA, Like we used that
acronym as a word all the time, But when you
really think about, like someone had to go and investigate
all of these things into TRUM and that there was
a very clear link between some of the work that
was happening and some of the illnesses that were resulting,

(24:39):
uh and document all of it so that there could
be a clear case made. And it was largely uh,
you know, her instigating it in the United States at least,
there was, as we mentioned, uh, stuff going on in
other parts of the globe where they had already begun
that kind of research. But Alice Hilton sure love her.
I also noticed, in case anyone's curious, when you look
at by agraphies of her, Uh, she isn't very often

(25:04):
addressed as Dr Alice Hamilton's and I think that's because
she didn't go into practice as a medical doctor but
instead took this research route. But she did finish medical
school and wasn't mp D, So we kind of switched
a little bit and included it periodically just to remind people. Um,
but I don't think she went by Dr Hamilton's on
the regular in her day to day life. Thanks so

(25:28):
much for joining us on this Saturday. Since this episode
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(25:49):
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(26:12):
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