CSTE celebrates March 2023 as Women’s History Month

As Women’s History Month comes to a close, CSTE is featuring Alice Hamilton, the “first female epidemiologist” and a pioneer in industrial health and safety. We are pleased to celebrate the importance of women in occupational health and epidemiology.

Alice Hamilton: Industrial Health Pioneer and the First Female Epidemiologist

When we think about women fighting for worker protection and workplace reform, images from movies like “Silkwood” and “Norma Rae” may spring to mind – everyday people protesting and trying to better their work environments. Those characters (and their real-life inspirations) made critical improvements, but we can go much further back in history to see the beginnings of women’s influence on safety for all workers.

During the late Industrial Revolution, social reformers like Jane Addams were beginning to lay the groundwork for women’s, children’s, workers’ and immigrants’ rights in the U.S. At Hull-House, a “settlement house” in Chicago, Addams and other reformers lived and worked closely with poor, working-class immigrant families. They focused on addressing the social and health issues created by urbanization and industrialization, including housing shortages and unsanitary living conditions.

Working conditions for the area’s poor also created health issues. However, at that time there were no legal protections for workers in the numerous mills, plants and factories across the country. In fact, no official connection had even been made between occupations and health.

Enter Alice Hamilton, a pioneer in industrial health and safety and the “first female epidemiologist.”

Hamilton was born into a prominent family in Indiana in 1869. She graduated from medical school at the University of Michigan in 1893 and moved into Hull-House several years later, opening a well-baby clinic and treating residents of the settlement house neighborhood.

As she came to know local families, Hamilton saw firsthand the diseases and injuries resulting from dangerous conditions, industrial accidents, and exposure to poisonous substances like lead and mercury. In her autobiography, “Exploring the Dangerous Trades: The Autobiography of Alice Hamilton, M.D.,” she said her experiences at Hull-House aroused her interest in industrial diseases. “Living in a working-class quarter, coming in contact with laborers and their wives, I could not fail to hear tales of dangers that workingmen faced, of cases of carbon-monoxide gassing in the great steel mills, of painters disabled by palsy, of pneumonia and rheumatism among the men in the stockyards.”

In 1910, Hamilton made her first formal investigation into the connection between the workplace and disease. The governor of Illinois appointed a commission to study industrial illness, particularly the high mortality rates due to industrial poisoning in the lead and associated enamelware industries, rubber production, painting trades, and explosives and munitions. Hamilton directed the survey and focused on lead – the most widely used industrial poison – while others on the team reported on arsenic, brass manufacturing, zinc smelting, turpentine and carbon monoxide.

The Illinois report proved the connection between occupation and illness. In 1911, the state’s legislature passed an occupational disease law requiring employers to implement new safety procedures, provide monthly medical examinations for workers in dangerous trades, and report illnesses to the Department of Factory Inspection.

Dr. Karla Armenti, research assistant professor at the University of New Hampshire and a member of the CSTE Occupational Health Subcommittee, stresses the importance of Hamilton’s efforts in making the connection between work and health. “Alice Hamilton’s work at Hull-House was critical, because of course there was no pollution prevention then, no workplace protections,” she said. “Hamilton and Jane Addams really made the link between work and exposure and workers’ health. They were like urban industrial environmentalists.”

Hamilton’s work in Illinois led to similar studies for the U.S. Bureau of Labor. As with the earlier survey, she carefully studied hospital records to connect specific illnesses and occupations and thoroughly investigated factories to learn which processes used dangerous chemicals. Over the years, her many reports for the federal government – first regarding the lead trades, then other dangerous trades – illustrated the high mortality rates in these occupations and brought about many landmark changes in state and federal industrial safety legislation.

CSTE Executive Director Janet Hamilton (no relation to Alice) emphasizes the importance of Hamilton’s perspective as a woman. “We need women in occupational health to really see the women in the workforce, to study the jobs that are often not seen otherwise. It goes back to the roots of epidemiology – demos, the people – if you don’t know or understand the people, you don’t know the questions to ask or the things to look for.” Her grandmother immigrated to the U.S. as a child with only her brother, working as a maid for years. “Definitely no one was looking at her job or the hazards associated with it,” she said.

Alice Hamilton joined the industrial medicine faculty at Harvard Medical School in 1919, becoming the first woman on the Harvard faculty. She taught one semester each year so she could continue her investigative work and return to Hull-House every spring. While at Harvard, she wrote “Industrial Poisons in the United States” (1925), the first textbook in the field, and “Industrial Toxicology” (1934).

Dr. Armenti enjoys teaching her own students about Hamilton in Occupational and Environmental Health classes. “Hamilton looked at the intersection of the social, political and economic worlds and how that connects to public health and worker health,” she said. “Her work was one of the first times people weren’t just responding to illness afterwards but looking to prevent it in the first place.”

After mandatory retirement at age 65, Hamilton continued her focus on social issues, campaigning against McCarthyism and the U.S. war in Vietnam. Recognitions for her 100th birthday included a telegram from President Nixon praising her successes in industrial medicine. She died on September 22, 1970, at the age of 101. Three months later, Congress passed the Occupational Safety and Health Act.

Janet Hamilton believes recognizing Alice Hamilton and her work helps all women in the field. “Seeing people like yourself in elevated positions is so important and can be a great influence,” she said. “It’s so helpful in paving that path. Public health needs are great and many, and the perspectives that women bring that no one else can bring to the table are completely inspiring,” she said.

It makes me hope, that the day is not far off when we shall take the next step and investigate a new danger in industry before it is put into use, before any fatal harm has been done to workmen…and the question will be treated as one belonging to the public health from the very outset, not after its importance has been demonstrated on the bodies of the workmen.” – Alice Hamilton