Alice Hamilton and the Development of Occupational Medicine

Hazards of the workplace

The United States underwent rapid industrialization after the Civil War and by the end of the nineteenth century it had become the world’s foremost industrial nation. The explosive growth occurred in many areas: manufacturing, mining, transportation, and commerce. Rapid industrialization was made possible by abundant resources, available and cheap energy, emerging technology, an expanding transportation system, capital accumulation for investment, and a ready supply of cheap labor augmented by an influx of immigrants. Industrialization resulted in lower prices for manufactured goods and higher living standards.

But industrialization came at a cost. It produced vast disparities in wealth and frequent cycles of boom and bust. For workers, rapid industrialization meant low wages, job insecurity, and dangerous working conditions. Industrial accidents and illnesses such as respiratory diseases became more and more common. Those who worked in the "dangerous trades" were at particular risk. In manufacturing and related fields, workers handled poisonous chemicals, breathed toxic dust and fumes, seldom washed their hands before eating, and wore clothing covered with poisons. Mercury poisoning in the felt hat industry caused uncontrollable jerking of arms and legs and mental illness: hence the phrase "mad as a hatter." Those who made matches were subject to "phossy jaw," an industrial disease that resulted from breathing fumes of white or yellow phosphorous which could penetrate the jawbone. The complications were severe, sometimes resulting in removal of the lower or upper jawbone, or both.

Lead, which enters the body slowly, was the most widely used toxic chemical in early twentieth-century industry. Workers in many industries were at risk of lead exposure, including those in the pottery and enamel trades, paint manufacturing, lead smelting and refining, and storage battery manufacturing. No one knew the precise extent of lead poisoning in the years before the First World War, but the toll in illness and even death was great. (Investigators were then unaware of the danger of lead poisoning in the general population, especially among children). Repeated small doses left no immediate symptoms, but since the body only slowly eliminates lead, the metal in time accumulates in sufficient amounts and causes severe poisoning. In acute cases, lead poisoning resulted in colic and convulsions. Lead harmed the nervous system, causing paralysis, most obvious in what was called wrist drop. In cases of chronic lead poisoning, victims suffered from loss of appetite and weight, constipation, high blood pressure, anemia, abdominal pain, fatigue, and premature senility. Pregnant women ran the risk of miscarriages and stillbirths.

Controlling the risks proved difficult. Many forms of industrial poisoning were not easy to recognize since it often took years for the most toxic effects to occur. Few studies of occupational diseases existed, leaving both employees and employers ignorant of the dangers from chemicals in the workplace. Few factories employed doctors to monitor the health of their workers. Many of the more dangerous trades employed unskilled labor fearful of their job security if they complained about unsafe conditions. And many of these workers were immigrants who often did not speak English, making it difficult for them to appeal to the appropriate authorities.


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