‘...I went as a pioneer into a new, unexplored field of American medicine, the field of industrial disease.’ One hundred years ago Alice Hamilton described what was to become one of the commonest occupational diseases of the 20th century—a condition subsequently called hand-arm vibration syndrome (HAVS) . In a chapter in her autobiography, titled ‘Dead Fingers’, she wrote ‘The men call the condition “dead fingers” and it is a good name, for the fingers do look like those of a corpse, a yellowish-greyish white and shrunken. There is a clear line of demarcation between the dead part and the normal part ... some said they could not tell a dime from a nickel without looking’ . Yet there was so much more to Alice than just an early identifier of HAVS. She was not only a pioneer for women in medicine, along with social and welfare reforming, but specifically for what was to become the four key pillars in the practice of modern occupational medicine: clinical history and examination, workplace observation, toxicology and epidemiology. To achieve this she had to overcome negative 19th century attitudes towards women and the division of labour with her own form of peripatetic epidemiology, pitting herself against rebarbative employers sometimes interviewing employees in bars, sleeping in mining shacks, being mistaken for a prostitute and talking her way into defensive manufacturing companies . Alice was born into a second-generation Irish immigrant family in 1869 in Manhattan, New York. The family ran a successful wholesale grocery business centred at Fort Wayne, Indiana, where she enjoyed a comfortable upbringing. The second oldest of five siblings she went on to graduate from Michigan Medical school in 1893 and after an internship decided to concentrate her early studies on pathology and bacteriology. Her path into occupational medicine, no doubt redolent to many doctors, was a combination of serendipity, drift and a disenchantment with conventional medicine. She read Sir Thomas Oliver’s compendium on the Dangerous Trades and thought it unlikely that similar afflictions would not be apparent in the USA . However, at the beginning of the 20th century America lagged behind Europe in recognizing industrial disease, health and safety law, employer responsibility and worker’s compensation. At the time she was living in one of the early settlement houses in Chicago (Hull House) set up by social reformers Jane Addams and Ellen Gates Starr to narrow the educational and social gap between rich and poor. There Alice was exposed to working class conditions and ill-health in a poorly paid immigrant labour force. Alice published her first article on the particular aspects affecting women in the workplace . However, the start of her own exploration into the dangerous trades was not initiated until 1910 when she received a request from the Governor of Illinois to investigate not ‘where violent accidents occurred, but those with the less spectacular hazard of sickness from industrial poison’ . Initially she carried out informal factory visits as no authority to access any plants was agreed and all reports were to be anonymized. In the background she set her small band of assistants to searching hospital records and interviewing doctors and apothecaries who were tending to the working classes—data protection, confidentiality and ethical approval were all issues for the future! A case of colic and wrist drop in a red lead bathtub enameller was the first case of poisoning by inhalation and previously unreported in the European literature . Thanks to a patient and iterative dialogue with feudalistic employers, who attributed cases of plumbism to either poor hand hygiene or alcoholism, she persuaded many to agree to preventative measures and employ doctors ahead of legal requirements. Among a number of other conditions covered during the Illinois survey they included arsenic, carbon monoxide, occupational deafness, miner’s nystagmus and many more. Her interest in women’s rights, peace movements and suffrage developed under Jane Addams’ influence while living at Hull House . She attended the International Congress of Women at The Hague in 1915. The meeting’s aim was to show the international suffrage movement’s protest at the war which not unsurprisingly met with a negative reaction in the USA with Theodore Roosevelt evidently describing their actions as ‘silly and base’ . Although initially sceptical herself about any possible effect this group might have she became a committed pacifist. The sinking of the Lusitania and America’s entry into the war left Addams and Hamilton isolated in a minority. Somewhat ironically the National Research Council approached her in 1918 to support research into the effects of trinitrotoluene (TNT) in shell-loading munition plants. Swallowing her pacifism and deploying an early example of biological monitoring she was able to determine the best solutions to avoid dust and skin absorption. The Department for Labor sent Alice to Bedford, Indiana, in 1917 with the backing of the American Association for Labor Legislation to investigate ‘injuries caused by use of the air hammer, saying that physicians had told them its use would be followed by tuberculosis, paralysis, neurasthenia, [and] insanity’ . Alice went on to describe ‘dead fingers’ and encapsulated the problems encountered in this ‘curious branch of medicine’; ‘… the sort of evidence that one must expect to find ... . where the clear waters of truth are so often muddied by mutual antagonisms, quarrels over wages and hours, and over unionization, and also, I am afraid, by the intense class consciousness of not a few physicians’. Alice was appointed assistant professor of industrial medicine at Harvard Medical School in 1919 when it was still a fortress of masculinity and had to accept a number of obtuse compromises which included desisting entering the Harvard Club and relinquishing her quota of football tickets. A first and only woman among men she adopted a deferential and self-deprecating manner which would accompany her for the rest of her career. This attitude contrasted starkly with a contemporary, Joseph Aub, at the medical school who, putting aside Sir Thomas Oliver, felt she knew more about industrial disease than anyone else in the world . Between this early period of her career and 1945 she published 55 articles including several in the Journal of Industrial Hygiene and Journal of the American Medical Association . In 1934 just before retirement she published Industrial Toxicology, a publication that would become a staple textbook on the subject. She continued to be an active civil libertarian in retirement attracting the attention of the Federal Bureau of Investigation as potentially subversive. While she was vocal on controversial issues such as McCarthyism and the Vietnam War her preferred style remained pragmatic and persuasive. Within months of her death at the age of 101 in 1970, as if an echo to a vanished spirit, the US Congress passed the Occupational Safety and Health Act. While her early work was little recognized at the time in America it was often cited in European publications, whereas the opposite is now the case; Donald Hunter quoted her as early as 1923 and when comparing the several pages of space devoted to Alice Hamilton in the fifth edition of Hunter’s Diseases of Occupations with only a passing reference in the tenth edition, hopefully, this article will again raise awareness of her legacy with a new generation of European occupational physicians. A default persona of self-deprecation often recognizable in high achievers litters her autobiography as evidenced by her disquiet in personal correspondence at being compared to Hippocrates and Ramazzini . Charles Turner Thackrah is often described as the ‘Father of Occupational Medicine’ . Alice Hamilton rightly deserves an equally hagiographic descriptor of the ‘Mother of Occupational Medicine’. References 1. Hamilton A . A study of spastic anaemia of the hands of stonecutters . United States Bureau of Labor Statistics, Bulletin 1918 ; 236 ( part 19 ): 53 – 66 . 2. Hamilton A. Exploring the Dangerous Trades: The Autobiography of Alice Hamilton . Boston, MA : Little, Brown, and Company , 1943 . 3. Sicherman B. Alice Hamilton, A Life in Letters . Cambridge, MA : Harvard University Press , 1984 . Google Scholar CrossRef Search ADS 4. Oliver T. Dangerous Trades: The Historical, Social and Legal Aspects of Industrial Occupations as Affecting Health, by a Number of Experts . London : John Murray , 1902 . 5. Hamilton A . Industrial diseases: with special reference to the trades in which women are employed . Charities Commons 1908 ; 20 : 655 – 658 . 6. Bryan MLM , Davis AF (eds). 100 Years at Hull-House . Bloomington, IN : Indiana University Press , 1990 . 7. Hamilton A. Exploring the Dangerous Trades: The Autobiography of Alice Hamilton, M.D . With a New Foreword by Jean Spenser Felton, M.D . Beverly, MA : OEM Press , 1995 . 8. Charles Turner Thackrah, 1795–1833, ‘The Father of Occupational Medicine’ . Occup Med (Lond) 2017 ; 67 : 251 – 253 . CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: firstname.lastname@example.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Occupational Medicine – Oxford University Press
Published: May 23, 2018
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