It is not so easy to understand why American physicians have neglected industrial plumbism - Alice Hamilton MD in 1914

Submitted by Norm Roulet on Fri, 02/18/2011 - 09:30.

Pathetic, unsafe public housing built at taxpayer expense in the pollution killing-fields of Mittal Steel Cleveland Works
Pathetic, unsafe public housing built at taxpayer expense in the pollution killing-fields of Mittal Steel Cleveland Works

As you read the following account of lead poisoning in America, you will come to realize physicians in America do not work for citizens, they work for corporations, and those corporations protect the interests of their owners, stockholders, and other corporations, rather than citizens, by using their physicians to hide from citizens the dangers of real environmental threats from industry, like lead poisoning. I brought this issue to the attention of realNEO readers with the publication of Perhaps the best way to eliminate bad climate science is to discredit bad lead poisoning scientists... starting with Dr. Schoen, and intend to provide the public with exhaustive ongoing analysis of this sad reality, harming all humanity.

Alice Hamilton MD was smart enough to understand this... very few American physicians have followed in her footsteps... none in Northeast Ohio, that I know of, ever. But if you've got a lot of money, or good corporate insurance, some doctors here may be able to repair your broken, polluted heart.

Her conclusion, from 1914 - "There is here a great neglected field in American medicine and one of growing importance, for each year the number of industrial establishments which employ physicians increases, and the opportunity for expert hygienic control of our dangerous trades increases. But there will have to be a more general understanding of the problems of industrial hygiene before the service rendered by the majority of company physicians becomes of much real value." That never happened - the "Tea Party" has been alive and well in America our entire post-Native history - humans physically and mentally polluted by Industry... the American Heritage... the unreal NEO way still today:

Lead Poisoning in the United States
Reprinted from: Hamilton A. Lead poisoning in the United States. Am J Public Health. 1914;4(6): 477–480

Figure 1

ONLY A FEW YEARS AGO, we were most of us under the impression that our country was practically free from occupational poisoning, that American match factories never were troubled by cases of phossy jaw, and that our lead works were so much better built and managed, our lead workers so much better paid, and therefore better fed, than the European, that lead poisoning was not a problem here as it is in all other countries.

The investigation made by John Andrews for the United States Bureau of Labor disillusioned us about our freedom from phosphorus necrosis, and the studies published by the New York State Factory Investigating Commission and by the United States Bureau of Labor Statistics are teaching us that, far from being superior to Europe in the matter of industrial plumbism, we have a higher rate in many of the lead industries than have England and Germany. As a matter of fact, the supposed advantages of the American lead worker, good wages, short hours, a high standard of living, obtain only in a few of the lead trades, such as house painting, plumbing (hardly a lead trade now), printing, and white ware pottery work. Art potteries, tile factories, white and red lead works, storage battery plants, and lead smelters and refineries pay the rate of wages given to unskilled laborers in that particular section and the work day is ten hours, while the standard of living is often very low, the men employed being for the most part foreigners with no permanent relation to the community in which they are working. When to these factors are added the almost universal absence of sanitary control of the work places and of personal care of the working force, it is easy to understand why we have much lead poisoning in industries which in Great Britain and Germany are comparatively safe.

It is not so easy to understand why we have so long been in ignorance on the subject, why American physicians and sanitarians, to whom all other questions of preventable disease are matters of the greatest interest, should for so long have neglected industrial plumbism, which their colleagues on the other side of the water had so effectively controlled. After all, it is a question for the public health men to solve, and, no matter what protective laws are passed by legislatures, we shall never really reform our lead trades until the sanitarians of the country grapple with the subject.

It will not take long to give a sketch of what we know about lead poisoning in the United States. The first published report was that of the Occupational Diseases Commission of Illinois. In 1911, 578 cases of lead poisoning were found to have occurred in the three preceding years, in Illinois, 308 of them in the last year and most of them in Chicago. About seventy different industrial processes had given rise to these cases.

Dr. John Andrews' analysis of 60 fatal cases of industrial plumbism in New York State was the next publication, appearing in Bull. 95 of the Bureau of Labor. This throws light on many occupations not ordinarily associated in the minds of physicians with the danger of lead poisoning.

Then the state of New York took up the study of this disease and so far, two reports have been published by the Factory Investigating Commission, the first under the management of E. E. Pratt, confined to New York City, and the second taking in all the state and conducted by Graham-Rogers and John H. Vogt. Doctor Pratt made an intensive study of several industries in New York, notably the white and red lead trade, the making of paints and colors, and the use of lead as a tempering agent. He found easily 121 cases of lead poisoning in this city in 1911, including only those that were relatively serious. Doctor Graham-Rogers' report covers practically every lead industry in the state, some of which, as the making of storage batteries, pottery work, the making of rubber, are described in full detail. The analyses of air made by Mr. Vogt show a state of contamination truly startling in certain industries. Thus in the mixing of materials in a rubber factory, as much as 8.0 mg. of lead were found in a cubic meter of air. As an adult breathes about 4.5 cm. in the course of ten hours, it follows that a workman here might inhale 36.0 mg. during his day's work. Legge1 says that 0.5 mg. in a cubic meter is the limit of safety, and Teleky2 says that a daily dose of 10 mg. may lead to severe symptoms in a few weeks. Other places in which these investigators found gross contamination of the air were near lead pots of solder or babbitt, where 5.0 mg. and 3.6 mg. and 2.6. mg. per cubic meter were found. In a storage battery factory they found in the pasting room 4.6mg. and in the lead-burning room, 2.6 mg.

The lead industries which have been studied intensively by the Federal Bureau of Labor3 are the making of white and red lead, the glazing of pottery and tiles, the enameling of sanitary ware, the painters' trade, the smelting and refining of lead and the making of storage batteries. The white lead industry in the United States is more dangerous than in England or Germany, because we use dry methods where they use wet, and therefore have a more serious dust problem. Owing partly to the evident risks, this industry has of late undergone great reforms, and in the majority of our plants there is a constant and intelligent effort to protect the men. The same thing is true of all but a few of the red lead factories.

Glazing of pottery and, to a slighter extent, decorating it, is one of our bad lead industries and yet not enough attention has been attracted to it to bring about the needed reforms. Fortunately, both New Jersey and Ohio, the two chief pottery states, are now concerning themselves seriously with industrial plumbism and the dangerous conditions in the potteries will probably soon disappear. This is the only lead trade studied by the Bureau in which women are employed.

Even more fraught with danger is the porcelain enameling of sanitary ware, bath tubs, sinks, etc. The red hot ware from the furnaces must be thickly dusted over with a ground glass containing soluble lead in proportions of 0.5 per cent. to 20.0 per cent. During the process, the air is cloudy with this dust, and enamelers suffer not only from tuberculosis but from acute and often severe lead poisoning. At the time the investigation was made, 1912, there were practically no provisions for cleanliness in these factories nor for dust prevention.

The painters' trade is regarded in all countries as the most difficult of all the lead trades to control, because it is carried on under such varying conditions. In factories, the same control can be exerted over painters as over the other workmen, but much of the painters' work is done outside factories. In the United States, the branches of the painters' trade in which the danger from lead is greatest are the painting of carriages, especially the wheels, interior house painting, ship painting and the painting of interiors of railway cars. This is because in all these branches much white lead is used and is sandpapered, producing lead dust, the worst feature in the painters' trade. Comparatively safe branches are the painting of agricultural machinery, wagons, automobile bodies, the exterior of freight cars, all of which are now usually painted by dipping or spraying and often with leadless paint.

The United States is a great lead-producing country and the smelting and refining plants visited in the course of the Government investigation employ some 7,500 men. Dust and fumes are the great dangers here, the provision of wash rooms and baths is not nearly as important as it is in such industries as white and red lead where the men are smeared over with soluble salts. In lead smelting, it is the fine dust and the volatilized oxides which give rise to poisoning. Our smelting industry does, to a certain extent, try to protect the workers from poisoning but though there are very few really shockingly bad plants, there are none that can be called admirable.

Storage batteries are assemblages of lead grates with a paste of lead oxides rubbed into the interstices. The workers are exposed to lead fumes in casting and in joining the plates together, and to lead oxide dust in making and applying the paste. It is in all countries regarded as one of the worst of the lead trades, and is hedged about with all sorts of restrictions. In the United States it has only very lately attracted any attention at all, and the conditions under which the work is done in our factories are conducive of a very high rate of poisoning.

Many of the establishments in which these manufacturing processes are carried on employ physicians to take care not only of accidental injuries but of sickness, especially lead poisoning. The opportunity which these men have of controlling the sanitary conditions in the plant is sometimes very well used. I have found company physicians-acting as sanitary experts, going through the plant with the superintendent and working out with him the problem of dust or fume prevention. Such physicians keep records of their cases and are able to see which department is sending in an undue share and needs clearing up. Unfortunately, this kind of physician is in the minority. Much more common is the man who stays in his office and lets the men come to him, who knows little or nothing of the conditions under which they work and is impressed with the idea that lead poisoning is chiefly caused by the men's own ignorance and carelessness. I have had many such doctors tell me seriously that it is the lead that gets under the finger nails which does the harm, and this while the men they were discussing were working in an atmosphere foggy with lead dust or fumes. I have had others tell me that the men will always suffer from lead poisoning as long as they refuse to wash before eating their lunch, and all the time I knew that the plants which employed these physicians had given the men no place to wash and no time to go home at noon and get clean. But they continue to preach cleanliness without ever troubling to find out if their advice can possibly be obeyed.

There is here a great neglected field in American medicine and one of growing importance, for each year the number of industrial establishments which employ physicians increases, and the opportunity for expert hygienic control of our dangerous trades increases. But there will have to be a more general understanding of the problems of industrial hygiene before the service rendered by the majority of company physicians becomes of much real value.

Footnotes

Reprinted from: Hamilton A. Lead poisoning in the United States. Am J Public Health. 1914;4(6): 477–480.

References

1. Legge, Ann. Rep. Chief Inap. Fact. and Workshops for 1912.

2. Teleky, Protokoll d. Sitzung d. gross. Rats d. Inst. f. Gewerbelhyg, 1912.

3. Bulletins 95, 104, 120, 140, 479.

 

 
Alice Hamilton (1869–1970): Mother of US Occupational Medicine

VOICES FROM THE PAST

 

 

Sherry L. Baron, MD, MPH and Theodore M. Brown, PhD

Sherry L. Baron is with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA. Theodore M. Brown is with the Department of History and the Department of Community and Preventive Medicine, University of Rochester, Rochester, NY

Correspondence: Correspondence should be sent to Sherry L. Baron, MD, MPH, National Institute for Occupational Safety and Health, 4676 Columbia Parkway R-17, Cincinnati, OH 45226 (e-mail: SBaron [at] cdc [dot] gov

 

ALICE HAMILTON, OFTEN referred to as the mother of US occupational medicine, was also one of a pioneering group of young women who formed part of Jane Addam's Hull House at the turn of the 20th century. Born in New York City and raised in Fort Wayne, Indiana, Hamilton earned her medical degree at the University of Michigan in 1893. Following internships in Minneapolis, Minnesota, and Boston, Massachusetts, she studied bacteriology and pathology in Germany and then at Johns Hopkins University in Baltimore, Maryland. She moved to Chicago in 1897 where she was appointed professor of pathology at the Women's Medical School of Northwestern University.1(p1–10)

While happy to find a professional position in her field, she was most excited about the opportunity to become part of Jane Addam's new settlement movement. Her life at Hull House exposed her to many of the leading progressive era activists and social reformers including Florence Kelley, the socialist, who fought against child labor and for the 8-hour workday. In her autobiography, Hamilton wrote, "In settlement life it is impossible not to see how deep and fundamental are the inequalities in our democratic country."2(p75) While living among the working class immigrant communities of Chicago, Illinois, she heard about their deplorable working conditions and she began reading studies by European occupational medicine researchers. When she asked US authorities about the existence of industrial poisoning she was assured that the European findings could not apply to American workers who "were so much better paid, their standard of living was so much higher, and the factories they worked in so much finer than the Europeans."2(p115) Alice Hamilton's training in pathology, combined with her intimate knowledge of working class life, and her ideals of social reform made her the spearhead of the occupational safety and health movement in the United States.3

In 1908 she was asked by the governor of Illinois to become a member of a commission investigating industrial illnesses. This Illinois survey led eventually to a larger federal survey which documented exposures to lead and other industrial toxins in factories throughout the country.1(p153–183) The method Hamilton used in her investigations combined factory inspections and interviews with workers in their homes "where they had courage to speak out what is in their minds."2(p125) In one investigation of lead poisoning in a bathtub factory, it was only after talking to the lead-poisoned worker that Hamilton discovered that the factory owners had never shown her the lead enameling process that led to the poisoning.2(p121)

In this article, first published in the American Journal of Public Health in 1914, Hamilton summarized the evidence for industrial lead poisoning. More importantly, this article is a call to action, directing physicians responsible for workers' health to leave the comforts of their offices to observe the work processes of their patients and to learn the truth about workplace exposures. This approach of documenting hazards by talking to workers and observing the realities of the workplace was the inspiration that would eventually lead many other researchers to also become workers' safety and heath reformers and activists.

Acknowledgments

Note. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

Footnotes

Contributors

S. L. Baron originated and conceptualized the project and wrote the first draft. T. M. Brown contributed to the conceptualization of the project and reviewed and edited the article.

Accepted for publication July 2, 2009.

References

1. Sicherman B. Alice Hamilton: A Life in Letters . Cambridge, MA: Harvard University Press; 1984:1–10.

2. Hamilton A. Exploring the Dangerous Trades . Boston, MA: Northeastern University Press; 1985.

3. Markowitz G, Rosner D. Deceit and Denial: The Deadly Politics of Industrial Pollution . Berkeley: University of California Press; 2002:12–35.

November 2009, Vol 99, No. S3 | American Journal of Public Health S547-S549
© 2009 American Public Health Association

...lead dust, the worst feature in the painters' trade

What is especially saddening is that Alice Hamilton and the few competent physicians of her time, who understood the hazards of lead and industry, were unable to protect ALL AMERICANS WHO HAVE LIVED THEN AND SINCE, WHO HAVE BEEN LEAD POISONED HERE AS A RESULT, CAUSING THE DOWNFALL OF AMERICA. There was never any real concern here for workers in the lead trades or their victims, like homeowners in the houses contaminated by incompetent, uninformed lead-poisoned painters STILL...

The painters' trade is regarded in all countries as the most difficult of all the lead trades to control, because it is carried on under such varying conditions. In factories, the same control can be exerted over painters as over the other workmen, but much of the painters' work is done outside factories. In the United States, the branches of the painters' trade in which the danger from lead is greatest are the painting of carriages, especially the wheels, interior house painting, ship painting and the painting of interiors of railway cars. This is because in all these branches much white lead is used and is sandpapered, producing lead dust, the worst feature in the painters' trade.

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the sure, slow public poison from the use of lead in gasoline

Fuels and Society B: 8. Alice Hamilton

One public health scientist, Alice Hamilton (1869-1970) of Harvard University, was particularly dismayed by the decision to allow leaded gasoline back on the market in 1926. 


Statue of Dr. Alice Hamilton at the Alice Hamilton Ocuupational Health Center in Ft. Wayne, IN

Used with permission

Hamilton was one of the most important researchers and advocates for safe working conditions in the hazardous trades. She was an M.D. who had done post-doctoral work at the Universities of Munich and Leipzig in Germany, at the Pasteur Institute in Paris, and at John Hopkins University in the U.S.   Her interest in what was called "occupational disease" was sparked by her years working with social activist Jane Addams at Chicago's Hull House, a settlement house in the middle of Chicago's working class slums where social activists lived and worked for progressive causes. Hamilton was to become the acknowledged national expert on lead toxicology, the first woman on the Harvard University faculty and a key figure in the Ethyl controversy.

 In 1910, the labor department of the state of Illinois hired her to look into the question of workers' compensation claims from the lead industry trades.  Hamilton found appalling conditions and  578 cases of outright lead poisoning, some of which were quite severe, or as Hamilton put it,  “equal to those described by French authorities of the early 19th century.”[i]

Shocked that Illinois was a century behind Europe, the legislature quickly passed a law requiring ventilation and other safety standards for workers.  The Illinois study brought Hamilton to the attention of the U.S. Department of Labor,  where she worked from 1910 to 1919 as a special investigator of industrial poisons. She was then invited to join the faculty at Harvard University, and was the first woman to do so. This was not out of egalitarian academic impulse but simply because she was by far the best occupational toxicologist in America, according to biographer Barbara Sicherman.[ii]Hamilton worked with notable tact to popularize the views of social reformers among labor leaders, fellow physicians and industrialists.[iii] In a speech to the superintendents of the National Lead Company, she praised their efforts to safeguard worker health while at the same time noting that their factories were “so dangerous ... that they would be closed by law in any European country.”[iv]

In 1920, she managed to obtain funding from the American Institute of Lead Manufacturers to study lead metabolism in the human body at Harvard.  The study found that lead did accumulate in the bones and tissues of people who were exposed to it, and was not quickly or fully metabolized and excreted. As a practical result, lead manufacturers were disappointed in their attempts to evade workers compensation claims and civil damage suits.[v]  A few years later, when General Motors began to put lead into gasoline,  Hamilton and others -- including Surgeon General Hugh Cumming --  felt that this study had already laid the key scientific issue to rest.  With the cumulative nature of the poison, no one could reasonably advocate the sure, slow public poison from the use of lead in gasoline.[vi]

[i] Ibid., p. 581.

[ii] Barbara Sicherman, Alice Hamilton: A Life in Letters (Cambridge, Mass., Harvard University Press, 1984),

[iii] Ibid., p. 33.

[iv] Ibid., p. 35.  

[v] Ibid, p. 238. 

[vi] Alice Hamilton, Paul Reznikoff and Grace Burnham, “Tetra Ethyl Lead,” Journal of the American Medical Association, May 16, 1925, pp. 1481-1486.

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