Image: Alice Hamilton, age 24. Michigan Historical Collections, Bentley Historical Library, University of Michigan.
We have seen time and time again, the enormous benefit that safety and health agencies provide to public health. It has become increasingly apparent that information provided to us through these agencies plays a pivotal role in keeping us safe, especially at work. It may be lesser known to some, however, that a female physician and pathologist was responsible for laying the groundwork for occupational medicine. Dr. Alice Hamilton is credited by the Occupational Health and Safety Administration (OSHA) as the founder of industrial medicine in America.
Alice Hamilton was born in 1869 and raised in Fort Wayne, Indiana. In her late teens, Alice decided to become a doctor. In her autobiography, she conceded, “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.” While it was not unheard of, her decision was unusual at the time. According to the anthology, Send Us a Lady Physician: Women Doctors in America, 1835-1920 by 1900, women made up only a minute percentage of practicing doctors – about 4 to 5%. Alice herself was one of 14 women in the 1893 graduating class at the University of Michigan’s medical program.
After graduating, she interned in Minneapolis, Minnesota, and Boston, Massachusetts and then studied pathology and bacteriology in Munich and Leipzig, Germany, under the stipulations that she remain “invisible” to her male peers and would under no circumstance receive a degree. When Alice returned to the United States in 1896, she continued her postgraduate studies at John Hopkins University until she accepted an offered position to teach at the Woman's Medical School of Northwestern University.
A focus on industrial hygiene
The position at Northwestern also provided an opportunity for Alice to live at Hull-House, a social settlement founded by Jane Addams which aimed to have more well-off community members assist immigrants and the poor by providing services such as classes and healthcare. While there, Alice published a paper about the transmission of scarlet fever in healthcare settings. She had patients known to be infected with scarlet fever cough and sneeze into petri dishes so she could study if viral particles were present. After determining that they were in fact present in respiratory droplets, Alice recommended that surgeons wear masks to prevent transmission.
It was her time at Hull-House that also opened her eyes to a variety of health issues which affected its working-class members. In her autobiography, she wrote, “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.”
In 1910, the governor of Illinois requested a survey to study the extent of industrial sickness throughout the state. Alice was appointed to serve as the managing director of the survey. As little was known at the time about industrial hygiene, the commission had to develop their own methodology and industries of interest. Hamilton and the other members of the commission visited factories, reviewed medical records, and conducted interviews with workers at their homes where they could feel more comfortable. Her autobiography recounts a particular example of a sanitary-ware worker who seemed to be experiencing symptoms of lead poisoning. His job was to apply enamel coating to bathtubs. While the factory managers assured her that lead was not used, and even granted her a tour of the factory, the employee told her that she was only shown part of the enameling process. Some work occurred at another factory where they were “sprinkling a finely ground enamel over a red-hot tub where it melts and flows over the surface.” A specimen given to her by the worker contained as much as 20 percent soluble lead.
Alice published her findings in the American Journal of Public Health and implored practicing physicians to leave the comfort of their offices and observe the work processes of their patients which could be attributing to their poor health. The Illinois Survey demonstrated the connection between workplace environments and illnesses which led to the Illinois legislature passing the Occupational Diseases Law of 1911. The law required employers to implement safety measures which limit the exposure of hazardous chemicals, provide monthly exams, and document illnesses for reporting.
After the success of the report, the U.S. Commissioner of Labor requested that Alice perform a similar report on a national scale. Alice continued to use her shoe-leather epidemiology methods – interviewing workers and factory owners and examining hospital records to determine connections between occupation and illness. She began her federal work by investigating white lead as it was commonly used throughout many industries. Many doctors at the time would not diagnose a patient with lead poisoning unless they were showing signs of colic or palsy, as diagnostic testing for lead levels were not yet available. Additionally, many employers operated under the notion that lead poisoning was due to the workers not washing their hands before eating. Alice noted that it was the inhaled fumes and dust that caused poisoning and as such, it was the employer’s responsibility to improve working conditions.
Her work in the field of industrial hygiene was highly regarded. So much so that she was sought out by the dean of the Harvard Medical School to join the faculty of their newly introduced program of industrial hygiene. She was appointed Assistant Professor of Industrial Medicine and became the first female faculty member; all while at a time when women were not yet allowed to matriculate. She accepted the appointment on the condition that she would only be required to teach one semester a year so she could continue her field studies and return to Hull-House. During her time at Harvard, Alice published the firsts texts related to the field of industrial medicine – Industrial Poisons in the United States in 1925 and Industrial Toxicology in 1934.
After her forced retirement at the age of 65 in 1935, Alice continued her work as a consultant to the U.S. Division of Labor Standards. Her last field report focused on serious illnesses affecting viscose rayon workers. Workers in these factories were exposed to carbon disulfide which resulted in manic-depressive episodes, loss of vision, hysteria, and paralysis. The results of her study were published in Occupational Poisoning in the Viscose Rayon Industry.
Alice remained a committed crusader for occupational health until her death on September 22, 1970, at the age of 101. Within three months, President Nixon signed the Occupational Safety and Health Act which created OSHA. On February 27, 1987, the National Institute for Occupational Safety and Health (NIOSH) dedicated its research facility as the Alice Hamilton Laboratory for Occupational Safety and Health. Alice Hamilton is often regarded as the Founder of Occupational Health in the United States. Due her dedication and compassion, the world is a much safer place, especially for workers.
Abram, R. J. (Ed.). (1985). Send Us a Lady Physician: Women Doctors in America, 1835-1920. Norton.
Centers for Disease Control and Prevention. (2012, April 26). History of Alice Hamilton, MD. Centers for Disease Control and Prevention. Retrieved March 8, 2022, from https://www.cdc.gov/niosh/awards/hamilton/hamhist.html
Hamilton, A. (2013). Exploring the dangerous trades: The autobiography of Alice Hamilton, M.D. Miller Press.
Nagy, K. (2019, October 23). The woman who founded Industrial Medicine. Scientific American Blog Network. Retrieved March 7, 2022, from https://blogs.scientificamerican.com/voices/the-woman-who-founded-industrial-medicine/
National Institutes of Health. (2015, June 3). Changing the face of Medicine | Alice Hamilton. U.S. National Library of Medicine. Retrieved March 7, 2022, from https://cfmedicine.nlm.nih.gov/physicians/biography_137.html