Alice Hamilton and the Development of Occupational Medicine


Alice Hamilton’s decision to live at Hull-House enabled her to participate in a great social movement. As Hamilton wrote in her autobiography during the Second World War "we had more faith in human nature, we really believed in a steady progress of mankind, we never dreamed that the pendulum would swing back and an age of barbarism would return." The first settlement, Toynbee Hall, was founded in London in 1884 with the intention of having university men "settle" in slums to help residents overcome poverty and misery and, in turn, to learn about "the real world" from the slum dwellers.

The settlement concept quickly spread to the United States and by 1910 there were over 400, most located in large cities. Initially, settlements were funded by donations and residents paid for room and board. Women led many of the American settlements, and many of them viewed the settlements as vehicles for social research and reform. In big cities, settlements tended to be located in ethnically diverse areas, where they helped immigrants adjust to life in a new land.

Jane Addams and Ellen Gates Starr founded Hull-House, the third American settlement and the first with men and women residents, in 1889 on Halsted Street on Chicago’s Near West Side. The residents of Hull-House formed an impressive group, but it was Jane Addams who best articulated the theory and function of the settlement and the relationship between the middle-class residents and the poor of the neighborhood, the city’s 19th Ward. According to Addams, Hull-House gave the well educated a sense of purpose and a chance to use their learning in a socially beneficial way. In turn, the poor received educational benefits and social services otherwise unavailable, and immigrants found in the settlement an institution that respected and cultivated their customs.

The residents of Hull-House lived in a sea of poverty, disease, and misery. "The streets are inexpressibly dirty," Addams wrote in Twenty Years at Hull-House, "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." On those streets, English was not often heard, as the 19th Ward was home to Italians, Irish, Jews, Greeks, and many other ethnic groups.

Hull-House was responsible for many Chicago firsts: first public baths, first public playground, first public kitchen, first college extension courses, first public swimming pool, and first gymnasium for the public. Hull-House sponsored the first little theater in the United States, in keeping with Addams view that beauty and culture should be available to everyone. Hull-House residents conducted investigations of family income, school truancy, sanitation, tuberculosis, cocaine distribution, infant mortality, and many other issues affecting the health and safety of the community. The settlement ran a kindergarten and nursery, a music school, and an art gallery. It spawned the Juvenile Protective Association and contributed to founding the world’s first juvenile court. Hull-House residents taught English and citizenship and organized the Immigrants’ Protective League to assist immigrants with legal problems. Hull-House also helped organize labor unions at a time when many middle- and upper-class Americans opposed such organizations.

Alice Hamilton may have found living at Hull-House congenial since she came from a large, closely-knit family in which women played a dominant role. Like many of the residents of Hull-House, Hamilton had a day job, in her case teaching at a medical school, so participation in settlement activities was limited to evenings and weekends. Her greatest contribution was opening a well-baby clinic, which soon ministered to children up to eight years old. The clinic’s main function was providing baths for the children. She also advised the mothers on diet, urging only milk until their teeth came in. But she soon realized that the solid food the mothers gave their babies did no harm, adding, "those Italian women knew what a baby needed far better than my Ann Arbor professor did." She tried without much success to educate the mothers about the dangers of contagious diseases.

In 1902, when the Women’s Medical School of Northwestern University closed, Alice Hamilton accepted a position as bacteriologist at the newly opened Memorial Institute for Infectious Diseases, a post that gave her the chance "to bring my scientific training to bear on a problem at Hull-House." Returning that fall from her customary summer vacation on Mackinac Island, Hamilton found Chicago in the grip of a severe typhoid epidemic, with the area around Hull-House the hardest hit. Hamilton prowled about the neighborhood looking for local conditions to explain the high number of typhoid cases in the 19th Ward. She noted numerous outdoor privies, broken plumbing, standing water, and swarms of flies. She soon concluded that the flies were feeding on typhoid-infected excrement and then lighting on food. Tests on flies captured near filthy water closets and in kitchens indicated the presence of the typhoid bacillus, apparently confirming the link between the insects, contaminated water, and inadequate sewage disposal.

In her autobiography Hamilton wrote "I am sure I gained more kudos from my paper on flies and typhoid than from any other piece of work I did." But she soon discovered that the flies had little to do with the spread of typhoid in the district. The real culprit was a broken water main that spewed sewage into water pipes, a cause more discreditable to the Chicago Board of Health, which had covered up the break. "The truth," Hamilton stated, "was more shocking than my ingenious theory… For years, though I did my best to lay the ghosts of those flies, they haunted me and mortified me."

With the typhoid probe behind her, Hamilton began to focus on issues of public health. Her examination of the causes of tuberculosis made the connection between unsanitary conditions, fatigue from fourteen-hour workdays, and the disease, an early example of her professional interest in the link between occupation and illness. Living in a working-class district sparked Hamilton’s curiosity about industrial diseases, especially those plaguing women in the workplace, and in the first decade of the twentieth century she began to concentrate on the study of industrial toxicology.

Hamilton lived full-time at Hull-House until 1919, when she accepted a post at Harvard Medical School. Until 1935, Hamilton taught only the fall semester of each year so that she could live at Hull-House for several months in the spring. When Jane Addams died in 1935, Hamilton was mentioned as a possible successor, but she declined.

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