Dr. Alice Hamilton: a Hoosier Woman Who Established an Entirely New Field of Life-Saving Science in Early 1900s America

Here in the 21st century, we take for granted some pretty amazing achievements in public health that make our lives safer and better.  These modern miracles of science, technology, and public health include vaccines, car safety, food safety, the strides we’ve made in decreasing infant and maternal mortality, infectious disease control, cavity prevention using fluoride, and more.   

For one of these 20th-century health triumphs – workplace safety – a remarkable Midwestern woman pioneered one of the core sciences underpinning the modern field.  That Indiana-born woman and Michigan-trained doctor, who did her most ground-breaking research in Illinois, was Alice Hamilton.  If you haven’t heard of this extraordinary scientist and M.D., get ready to be blown away – as I have been over the last couple years.  The most basic details of her accomplishments are an inspiration to anyone who loves STEM (science, technology, engineering, and math), and her contributions to well-being in the workplace show the power and role of science in advancing protections for American workers.  

Among her many achievements, I am most inspired by her groundbreaking work in industrial toxicology, the study of hazardous chemicals in factories, in the early 20th century – from 1908 through the early 1920s.  She pioneered a new field of science at a time when women were denied their right to vote in all but a handful of states.  It was also a time when we didn’t even protect kids from the most dangerous child labor conditions, let alone adults.  It is no wonder that we did not understand basic issues of chemical exposures in the workplace at that time.  

It was standard and common for people to work with large amounts of dangerous chemicals with virtually no protective equipment or safety precautions.  Safety equipment generally did not exist and safety precautions were often not taken with chemicals that commonly harmed workers, such as lead, radioactive radium, mercury, and thousands of other compounds.  Factories owners did not concern themselves with chemical safety partly because they did not understand different chemicals and how to work with them safely, and partly because workplace culture and laws did not prioritize such chemical safety.  But soon, Dr. Hamilton became the nation’s leading expert in the field and led the way in revolutionizing our understanding of toxic substances in the workplace.

Dr. Hamilton started her scientific work in occupational medicine, during her tenure at Hull House in Chicago.  Hull House was a renowned settlement house, which brought well-to-do young professionals to live in immigrant neighborhoods to work with impoverished and working-class people.  The House was founded by Jane Addams and frequented by reformers such as Florence Kelley, a child labor activist, and Julia Lathrop, the first head of the Children’s Bureau.  Dr. Hamilton worked closely with all three of these women.

From left to right: Jane Addams, Alice Hamilton, Florence Kelley, Julia Lathrop

While dedicating herself to programs such as establishing a well-baby clinic at Hull House, Dr. Hamilton saw the effects of misunderstood occupational diseases first-hand.  One example of the kinds of symptoms she learned about were the extreme effects of lead poisoning. Often called “lead palsy” and “wrist drop” at the time, lead poisoning was so extreme that it paralyzed the radial nerve (which runs from your elbow to the inside half of your hand) causing people to lose their ability to extend their wrists and fingers.  Such symptoms from chemical exposures, combined with seeing residents – especially women – of the neighborhood working exhausting hours and living in hard conditions, inspired Dr. Hamilton to review European work on industrial toxins.  She studied European literature because Europe was far ahead of the U.S. in advancing chemical safety in the workplace. She published a review of this European work in 1908, titled “Industrial Diseases with Special Reference to the Trades in which Women are Employed,” in Charities and the Commons.

Left: A tenement apartment near Hull House. Right: Hull House’s “backyard.” Both photos were taken by the famous social reform photographer Lewis Hine, in 1910. Center bottom: A photo of “double wrist drop” from a publication advocating for protections from occupational diseases, including lead poisoning, by John Andrews, Secretary of the American Association for Labor Legislation, in 1913.

The hardcore research that made Dr. Hamilton the “Mother of U.S. Occupational Medicine” began that same year when Charles Deneen, the governor of Illinois, appointed her to the Illinois Commission on Occupational Diseases.  This commission was charged with conducting investigations that would be the basis for new workplace safety legislation, and by 1910, Deneen promoted her to supervise the commission.  She took on conducting special investigations on lead poisoning for the commission herself, and she managed all of the commission members’ investigations into other hazardous substances, including arsenic, turpentine, carbon monoxide, and chemicals in the zinc and brass industries.  She authored the commission’s final report while still making Hull House her home base.  The report documented the links between chemicals and disease that investigators had found, and it identified the “dangerous trades” in which these exposures caused death and disease.  Those investigations and the commission’s report formed the basis for the Illinois legislature passing one of the first occupational health laws in the U.S. targeting chemical safety.  The law required that “dangerous trades” implement safety procedures, provide medical examinations to workers, and report illnesses to a central authority.

Hull House’s role in Dr. Hamilton’s influential work led the American Chemical Society to designate it as a National Historic Chemical Landmark in 2002.

Dr. Hamilton’s work for Illinois also led to her conducting similar survey and medical investigation work at the federal level, starting in 1911.  Her federal research took her all over the United States and involved gaining access to factories, interviewing workers in their homes and pubs, and gathering data from hospitals – classic work in “shoe leather epidemiology.”  Her work on a national scale, combined with her prolific publications in scientific journals, government reports, and more popular publications, led other states around the nation to pass workplace safety legislation similar to Illinois’ groundbreaking law.

One of Hamilton’s scientific achievements was her investigation for the Bureau of Labor of white lead and lead oxide in 1912.  Her report, titled, “The White Lead Industry of the United States, with an Appendix on the Lead Oxide Industry,” detailed findings from inspections of 22 of the 25 white lead factories in the United States, along with data from hospitals, dispensaries, local physicians, and druggists in the areas of the factories.  She documented over 350 cases of lead poisoning in a little over a year, including 16 that caused death. Her report included statistics grouped by the type of factory and how long each worker was employed. She also reported on illustrative descriptions of individual case histories and described highly detailed accounts of the factory processes and chemistry, with particular attention paid to how white lead dust could be better controlled.

Before she even wrote her report, Dr. Hamilton saved lives with data and evidence.  She described the problem of factory managers’ ignorance of the true burden of disease due to factory conditions.  She discovered that workers were often short-term and no longer at the factory once sick or dead. She worked to educate managers upon completion of her inspections.

In one impactful case, a factory manager challenged her to find a single case of white lead poisoning “for which his factory was responsible.”  She, in fact, found 21 cases that had occurred over 2 years, and as a direct result, the manager immediately hired a physician as a medical examiner for the factory, “a measure he had up to that time considered quite superfluous.”  Eleven factories in total significantly changed their operations straight away upon Dr. Hamilton’s recommendations in meetings after her inspections.

Hamilton investigated a wide variety of substances throughout the 1910s and early 1920s.  For example, she also examined trinitrotoluene (TNT) production during World War I, mercury poisoning as the cause of “hatter’s shakes,” effects of benzene, toluene, xylene, and derivatives – particularly aniline – on workers in the coal-tar dye industry, and carbon monoxide poisoning among steelworkers.

In 1918, Hamilton, as the leading full-time expert in occupational medicine, was hired as the first female faculty member at Harvard.  She faced discrimination and sexism during all of this work, but she kept breaking barriers. Upon her appointment at Harvard, the headline in the New York Tribune read, “A Woman on Harvard Faculty—The Last Citadel Has Fallen—The Sex Has Come Into Its Own.”  She taught for a semester each year and spent the rest of the year continuing her research, travels, and residency at Hull House, until she retired from Harvard in 1935.  Then, she continued to work on industrial toxicology investigations for the federal government, including authoring a major report on the roles of carbon disulfide and hydrogen sulfide in health hazards for workers from the viscose rayon industry.  This report helped lead Pennsylvania to pass its first workers’ compensation law.

Dr. Hamilton’s science, data, and scholarship contributed to protections for American workers from chemical hazards on all fronts.  Her work formed the foundation of smart legislation based on solid evidence. She convinced private companies to make voluntary changes in workplace practices.  And she taught the next generation of scientists in her field while writing seminal texts, government reports, and research in the primary scientific literature.  Dr. Alice Hamilton was an amazing scientist who blazed trails, broke barriers for women, and helped save American workers by making workplace safety science- and evidence-based.