Nineteenth-century laborers faced a variety of work-related ailments: from rheumatism and pneumonia to lead palsy and carbon monoxide poisoning. Yet governments rarely regulated workplace conditions and the United States lagged far behind industrialized European nations in such regulation. In the Progressive era, however, a movement to regulate dangerous industrial working conditions arose, and one of its most prominent leaders was a physician named Alice Hamilton. In this selection from her 1943 autobiography, Hamilton described her residency at Jane Addams’s Hull House in the late 1890s and her participation in the Illinois Occupational Disease Commission.
It was also my experience at Hull-House that aroused my interest in industrial diseases. Living in a working-class quarter, coming in contact with laborers and their wives, I could not fail to hear tales of the dangers that workingmen faced, of eases of carbon-monoxide gassing in the great steel mills, of painters disabled by lead palsy, of pneumonia and rheumatism among the men in the stockyards. Illinois then had no legislation providing compensation for accident or disease caused by occupation. (There is something strange in speaking of “accident and sickness compensation.” What could “compensate” anyone for an amputated leg or a paralyzed arm, or even an attack of lead colic, to say nothing of the loss of a husband or son?) There was a striking occurrence about this time in Chicago which brought vividly before me the unprotected, helpless state of workingmen who were held responsible for their own safety.
A group of men were sent out in a tug to one of Chicago’s pumping stations in Lake Michigan and left there while the tug returned to shore. A fire broke out on the tiny island and could not be controlled, the men had the choice between burning to death and drowning, and before rescue could arrive most of them were drowned. The contracting company, which employed them, generously paid the funeral expenses, and nobody expected them to do more. Widows and orphans must turn to the County Agent or private charity—that was the accepted way, back in the dark ages of the early twentieth century. William Hard, then a young college graduate living at Northwestern Settlement, wrote of this incident with a fiery pen, contrasting the treatment of the wives and children of these men whose death was caused by negligence with the treatment they would have received in Germany. His article and a copy of Sir Thomas Oliver’s Dangerous Trades, which came into my hands just then, sent me to the Crerar Library to read everything I could find on the dangers to industrial workers, and what could be done to protect them. But it was all German, or British, Austrian, Dutch, Swiss, even Italian or Spanish—everything but American. In those countries industrial medicine was a recognized branch of the medical sciences; in my own country it did not exist. When I talked to my medical friends about the strange silence on this subject in American medical magazines and textbooks, I gained the impression that here was a subject tainted with Socialism or with feminine sentimentality for the poor. The American Medical Association had never had a meeting devoted to this subject, and except for a few surgeons attached to large companies operating steel mills, or railways, or coal mines, there were no medical men in Illinois who specialized in the field of industrial medicine.
Everyone with whom I talked assured me that the foreign writings could not apply to American conditions, for our workmen were so much better paid, their standard of living was so much higher, and the factories they worked in so much finer in every way than the European, that they did not suffer from the evils to which the poor foreigner was subject. That sort of talk always left me skeptical. It was impossible for me to believe that conditions in Europe could be worse than they were in the Polish section of Chicago, and in many Italian and Irish tenements, or that any workshops could be worse than some of those I had seen in our foreign quarters. And presently I had factual confirmation of my disbelief in the happy lot of the American worker through the reading of John Andrews’s manuscript on “phossy jaw” in the match industry in the United States.
Phossy jaw is a very distressing form of industrial disease. It comes from breathing the fumes of white or yellow phosphorus, which gives off fumes at room temperature, or from putting into the mouth food or gum or fingers smeared with phosphorus. Even drinking from a glass which has stood on the workbench is dangerous. The phosphorus penetrates into a defective tooth and down through the roots to the jawbone, killing the tissue cells which then become the prey of suppurative germs from the mouth, and abscesses form. The jaw swells and the pain is intense, for the suppuration is held in by the tight covering of the bone and cannot escape, except through a surgical operation or through a fistula boring to the surface. Sometimes the abscess forms in the upper jaw and works up into the orbit, causing the loss of an eye. In severe cases one lower jawbone may have to be removed, or an upper jawbone—perhaps both. There are cases on record of men and women who had to live all the rest of their days on liquid food. The scars and contractures left after recovery were terribly disfiguring, and led some women to commit suicide. Here was an industrial disease which could be clearly demonstrated to the most skeptical. Miss Addams told me that when she was in London in the 1880s she went to a mass meeting of protest against phossy jaw and on the platform were a number of pitiful cases, showing their scars and deformities.
All this I had learned, but I had been assured by medical men, who claimed to know, that there was no phossy jaw in the United States because American match factories were so scrupulously clean. Then in 1908 John Andrews came to Hull House and showed me the report of his investigation of American match factories and his discovery of more than 150 cases of phossy jaw. It seems that in the course of a study of wages of women and children made by the Bureau of Labor, under Carroll Wright, investigators came across cases of phossy jaw in women match workers in the South. This impelled Wright to institute an investigation in other match centers. Andrews was asked to carry it out and did so, with a result most disconcerting to American optimism. Some of the cases he discovered were quite as severe as the worst reported in European literature—the loss of jawbones, of an eye, sometimes death from blood poisoning.
This episode in the history of industrial disease is very characteristic of our American way of dealing with such matters. We learned about phossy jaw almost as soon as Europe did. The first recognized case was described by Lorinser of Vienna in 1845; the first American case was treated in the Massachusetts General Hospital only six years later, in 1851. But while all over continental Europe and England there was eager discussion of this new disease, many cases were reported and all sorts of preventive measures proposed, practically nothing was published in American medical journals from 1851 to 1909, both laymen and public health authorities contenting themselves with the assurance that all was well in our match industry. When, however, the facts were at last made public in 1909, action was prompt. A safe substitute for white phosphorus had been discovered by a French chemist, the sesquisulphide, the American patent rights for which had been bought by the Diamond Match Company. This company with rare generosity, waived its patent rights and allowed the free use of sesquisulphide to the whole industry, and this made it possible for Congress to pass the Esch law, which imposed a tax on white-phosphorus matches high enough to cover the difference in cost between them and sesquisulphide matches. So phossy jaw disappeared from American match factories.
There were a few other voices in the wilderness. I remember a trip to Washington, to a medical meeting, when Frederick Hoffman of the Prudential Insurance Company gave us a demonstration, with statistics and charts, of the relation between occupation and tuberculosis. It was a startling eye-opener to me and I feel sure that I was not the only one who was hearing such facts for the first time. Dr. George M. Kober of Washington and Dr. William Gilman Thompson of New York were two other pioneers in this field, and only a few years later Josephine Goldmark published her famous brief on the employment of women in industry. So there were stirrings here and there, the flood was rising slowly.
At the time I am speaking of Professor Charles Henderson was teaching sociology in the University of Chicago. He had been much in Germany and had made a study of German sickness insurance for the working class (the Krankenkassen), a system which aroused his admiration and made him eager to have some such provisions made in behalf of American work men. The first step must be, of course, an inquiry into the extent of our industrial sickness, and he determined to have such an inquiry made in Illinois. Governor Deneen was then in office and Henderson persuaded him to appoint an Occupational Disease Commission, the first time a state had ever undertaken such a survey. Dr. Henderson had some influence in selecting the members and, as he knew of my great interest in the subject, he included me in the group of five physicians who, together with himself, an employer, and two members of the State Labor Department, made up the commission. We had one year only for our work, the year 1910.
We were staggered by the complexity of the problem we faced and we soon decided to limit our field almost entirely to the occupational poisons, for at least we knew what their action was, while the action of the various kinds of dust, and of temperature extremes and heavy exertion, was only vaguely known at that time. Then we looked for an expert to guide and supervise the study, but none was to be found and so I was asked to do what I could as managing director of the survey, with the help of twenty young assistants, doctors, medical students, and social workers. As I look back on it now, our task was simple compared with the one that a state nowadays faces when it undertakes a similar study. The only poisons we had to cover were lead, arsenic, brass, carbon monoxide, the cyanides, and turpentine. Nowadays, the list involved in a survey of the painters' trade alone is many times as long as that.
But to us it seemed far from a simple task. We could not even discover what were the poisonous occupations in Illinois. The Factory Inspector’s office was blissfully ignorant, yet that was the only governmental body concerned with working conditions. There was nothing to do but begin with trades we knew were dangerous and hope that, as we studied them, we would discover others less well known. My field was to be lead, Dr. Emery Hayhurst took brass, Drs. G. Apfelbach and M. Karasek, carbon monoxide in the steel mills. Caisson disease [a disease caused by work in compressed air when the return to normal air pressure is too quick] had appeared in the state, in connection chiefly with the construction of tunnels in Chicago, and Dr. Peter Bassoe undertook the study of the 161 cases of this disease which had occurred up to this date. Dr. George Shambaugh contributed a chapter on boiler makers' deafness and Drs. F. Lane and J. D. Ellis one on the rhythmic oscillation of the eyes of coal miners, known as nystagmus.
While we were visiting plants, we set our young assistants to reading hospital records, interviewing labor leaders and doctors and apothecaries in working-class quarters, for we must unearth actual instances of poisoning if our study was to be of any value. Thus I was put on the trail of new lead trades, some of which I had never thought of—for instance, making freight-car seals, coffin “trim,” and decalcomania papers for pottery decoration; polishing cut glass; brass founding; wrapping cigars in so-called tinfoil, which is really lead. Hospital records yielded cases from these and from many other jobs which were not mentioned in foreign textbooks.
One case, of colic and double wristdrop, which was discovered in the Alexian Brothers' Hospital, took me on a pretty chase. The man, a Pole, said he had worked in a sanitary-ware factory, putting enamel on bathtubs. I had not come across this work in the English or the German authorities on lead poisoning, and had no idea it was a lead trade, but the factory was easy to reach on the near West Side and I stopped in to ask about the man’s work. The management assured me that no lead was used in the coatings and invited me to inspect the workroom, where I found six Polish painters applying an enamel paint to metal bathtubs. So ignorant was I that I accepted this as the work of enameling sanitary ware, and did not even notice that all the men were painting the outsides of the tubs. I did note the name of the paint and went to the factory which produced it, but there I was told that enamel paint is free from lead. Completely puzzled, I made a journey to the Polish quarter to see the palsied man and heard from him that I had not even been in the enameling works, only the one for final touching up. The real one was far out on the Northwest Side. I found it and discovered that enameling means sprinkling a finely ground enamel over a red-hot tub where it melts and flows over the surface. I learned that the air is thick with enamel dust and that this may be rich in red oxide of lead. A specimen of it which I secured from a workman, who said he often took some home to his wife for scouring pans and knives, proved to contain as much as 20 per cent soluble lead—that is, lead that will pass into solution in the human stomach. Thus I nailed down the fact that sanitary-ware enameling was a dangerous lead trade in the United States, whatever was true of England and Germany.
It was pioneering, exploration of an unknown field. No young doctor nowadays can hope for work as exciting and rewarding. Everything I discovered was new and most of it was really valuable. I knew nothing of manufacturing processes, but I learned them on the spot, and before long every detail of the Old Dutch Process and the Carter Process of white-lead production was familiar to me, also the roasting of red lead and litharge and the smelting of lead ore and refining of lead scrap. From the first I became convinced that what I must look for was lead dust and lead fumes, that men were poisoned by breathing poisoned air, not by handling their food with unwashed hands. Nowadays that fact has been so strongly established by experimental proof that nobody would think of disputing it. But in 1910 and for many years after, the firm (and comforting) belief of foremen and employers was that if a man was poisoned by lead it was because he did not wash his hands and scrub his nails, although a little intelligent observation would have been enough to show its absurdity.
This fact, that lead poisoning is brought about far more rapidly and intensely by the breathing of lead-laden air than by the swallowing of lead, is of the greatest practical importance. There can be no intelligent control of the lead danger in industry unless it is based on the principle of keeping the air clear from dust and fumes. The English authority, Sir Thomas Legge, after some thirty years' experience in the prevention of industrial disease, reached the conclusion that the air is the only important source of occupational lead poisoning and that the only efficient measures for its prevention are those directed toward the prevention of dust and fumes. A hundred years ago Tanquerel des Flanches, who is called the Columbus of lead poisoning, noted that severe plumbism never followed the handling of solid lead but only exposure to dust and“emanations.”
Lead is the oldest of the industrial poisons except carbon monoxide, which must have begun to take its toll soon after Prometheus made the gift of fire to man. In Roman days, lead poisoning was known, for Pliny the Elder includes it among the “diseases of slaves,”which were potters‘ and knife grinders’ phthisis, lead and mercurial poisoning. Throughout all the centuries since then men have used this valuable metal in many ways, and from time to time an observant physician has seen the results and described them, notably Ramazzini in the eighteenth century, and early in the nineteenth century the great Frenchman, Tanquerel des Planches. It is a poison which can act in many different ways, some of them so unusual and outside the experience of the ordinary physician that he fails to recognize the cause. I could never feel that I had uncovered all the cases in any community, no matter how small, even after I had talked with all the doctors and gone through the hospital records, for some doctors would not pronounce a case to be due to lead poisoning unless there was either colic or palsy, which is as if he refused to recognize alcoholism unless there were an attack of delirium tremens.
It is true that a severe attack of colic is the most characteristic symptom of lead poisoning, and palsy—usually in the form of wristdrop—is the one most easily recognized, but there are many other manifestations of this protean malady, as every physician knows today. Thirty years ago it was not hard to find extremely severe forms, such as could come only from an exposure so great as to seem criminal to us now, but which then attracted no attention. Here are four histories, picked at random, from my notes of 1910.
A Bohemian, an enameler of bathtubs, had worked eighteen months at his trade, without apparently becoming poisoned, though his health had suffered. One day, while at the furnace, he fainted away and for four days he lay in coma, then passed into delirium during which it was found that both forearms and both ankles were palsied. He made a partial recovery during the following six months but when he left for his home in Bohemia he was still partly paralyzed.
A Hungarian, thirty-six years old, worked for seven years grinding lead paint. During this time he had three attacks of colic, with vomiting and headache. I saw him in the hospital, a skeleton of a man, looking almost twice his age, his limbs soft and flabby, his muscles wasted. He was extremely emaciated, his color was a dirty grayish yellow, his eyes dull and expressionless. He lay in an apathetic condition, rousing when spoken to and answering rationally but slowly, with often an appreciable delay, then sinking back into apathy.
A Polish laborer worked only three weeks in a very dusty white-lead plant at an unusually dusty emergency job, at the end of which he was sent to the hospital with severe lead colic and palsy of both wrists.
A young Italian, who spoke no English, worked for a month in a white-lead plant but without any idea that the harmless looking stuff was poisonous. There was a great deal of dust in his work. One day he was seized with an agonizing pain in his head which came on him so suddenly that he fell to the ground. He was sent to the hospital, semiconscious, with convulsive attacks, and was there for two weeks; when he came home, he had a relapse and had to go back to the hospital. Three months later he was still in poor health and could not do a full day’s work.
Every article I wrote in those days, every speech I made, is full of pleading for the recognition of lead poisoning as a real and serious medical problem. It was easy to present figures demonstrating the contrast between lead work in the United States under conditions of neglect and ignorance, and comparable work in England and Germany, under intelligent control. For instance, when I went to England in 1910, I found that a factory which produced white and red lead, employing ninety men, had not had a case of lead poisoning in five successive years. And I compared it with one in the United States, employing eighty-five men, where the doctor’s records showed thirty-five men “leaded” in six months.
In 1912, I wrote this in the Journal of the American Medical Association:
“The contrast was brought vividly home to me by a description which I found in T. Weyl’s Handbuch der Arbeiter-Krankheiten. He is drawing what he considers a shocking picture of ”lead tabes“ or ”lead cachexia" as it used to be found years ago, but which is now almost never seen, thanks to prophylactic measures. He describes the striking pallor, the hanging head, bowed shoulders, hands that hang limply and can hardly be raised; the shambling gait, trembling movements of all the muscles of the body, the emaciation which is extreme.
“From my own experiences I can unfortunately testify to the fact that, thanks to the lack of prophylactic measures, Weyl’s lead tabes is far from being a rare condition in our country; that instances of it can be found in every town where there are lead industries of a dangerous character, and that it is not even a vanishing condition, for new instances of lead tabes are being added to the number every year. Surely there is every reason why we should devote to this disease the same intelligence and energy that we devote to other preventable diseases.”
Life at Hull-House had accustomed me to going straight to the homes of people about whom I wished to learn something and talking to them in their own surroundings, where they have courage to speak out what is in their minds. They were almost always foreigners, Bulgarians, Serbs, Poles, Italians, Hungarians, who had come to this country in the search for a better life for themselves and their children. Sometimes they thought they had found it, then when sickness struck down the father things grew very black and there were no old friends and neighbors and cousins to fall back on as there had been in the old country. Often it was an agent of a steamship company who had coaxed them over with promises of a land flowing with jobs and high wages. Six hundred Bulgarians had been induced to leave their villages by these super salesmen, and to come to Chicago. Of course they took the first job they could find and if it proved to be one that weakened and crippled them—well, that was their bad luck!
It sometimes seemed to me that industry was exploiting the finest and best in these men—their love of their children their sense of family responsibility. I think of an enameler of bathtubs whom I traced to his squalid little cottage. He was a young Slav who used to be so strong he could run up the hill on which his cottage stood and spend all the evening digging in his garden. Now, he told me, he climbed up like an old man and sank exhausted in a chair, he was so weary and if he tried to hoe or rake he had to give it up. His digestion had failed, he had a foul mouth, he couldn’t eat, he had, lost much weight. He had had many attacks of colic and the doctor told him if he did not quit he would soon be a wreck “Why did you keep on,” I asked, “when you knew the lead was getting you?” "Well, there were the payments on the house,“ he said, ”and the two kids." The house was a bare, ugly, frame shack, the children were little, underfed things badly in need of a handkerchief, but for them a man had sacrificed his health and his joy in life. When employers tell me they prefer married men, and encourage their men to have homes of their own, because it makes them so much steadier, I wonder if they have any idea of all that that implies.
Source: Alice Hamilton, Exploring the Dangerous Trades: The Autobiography of Alice Hamilton, M.D. (Boston: Little, Brown and Company, 1943), 114–126.