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Vignettes of the History of Epidemiology Not to be Forgotten, Alice Hamilton, Pioneer Occupational Epidemiologist Warren Winkelstein, Jr., M.D., M.P.H.

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Presentation on theme: "Vignettes of the History of Epidemiology Not to be Forgotten, Alice Hamilton, Pioneer Occupational Epidemiologist Warren Winkelstein, Jr., M.D., M.P.H."— Presentation transcript:

1 Vignettes of the History of Epidemiology Not to be Forgotten, Alice Hamilton, Pioneer Occupational Epidemiologist Warren Winkelstein, Jr., M.D., M.P.H. Professor of Epidemiology (emeritus) University of California, Berkeley Quotations from Alice Hamilton: Exploring the Dangerous Trades Read by: Ellen A. Eisen, Sc.D. Adjunct Professor Divisions of Environmental Health Sciences & Epidemiology University of California, Berkeley School of Public Health Originally Presented at the 80 th Annual Meeting, AMERICAN EPIDEMIOLOGICAL SOCIETY, Harvard University Medical School, March 2007

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4 …Our education was very uneven with serious omissions. Fort Wayne had only public schools, and my mother objected to the long hours…. My father objected to the curriculum – too much arithmetic and American history; neither a subject that interested him…we had a smattering of mathematics…but I never got beyond the beginning of algebra. We learned what our parents thought important: languages literature, history. We had formal teaching only in languages; the other subjects we had to learn ourselves by reading, and we did…Of science we had not even a smattering… Alice Hamilton Exploring the Dangerous Trades pp

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6 -…Another of her traits was equally rare – her capacity for enthusiasms and for indignations over events and causes which had no personal bearing whatever. She could blaze out, even in her old age, over tales of police brutality, of the lynching of negroes, over child labor, and cruelty to prisoners. She made us feel that whatever went wrong in our society was a personal concern for us…Something she said once gives a picture of the atmosphere in which we girls grew up – “There are two kinds of people, the ones who say,” Somebody ought to do something about it, but why should it be I?”, and those who say, “Somebody must do something about it, then why not I?” Alice Hamilton Exploring the Dangerous Trades p.32

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8 …I chose medicine not because I was scientifically minded…I chose it because as a doctor I could go anywhere I pleased – to far off lands or to city slums – and be quite sure that I could be of use anywhere. I should meet all sorts and conditions of men, I should not be tied down…So I studied physics and chemistry…then entered one of those little third-rate medical schools which flourished before the American Medical Association reformed medical teahing…I spent a year studying anatomy…then I went on to Ann Arbor for a real course. Alice Hamilton Exploring the Dangerous Trades p. 38

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12 “It was…my experience at Hull-House that aroused my 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 the dangers that workingmen faced, of cases of carbon-monoxide gassing in the great steel mills, of painters disabled by lead palsy, of pneumonia and rheumatism among the men in the stockyards. Illinois then had no legislation providing compensation for accident or disease caused by occupation…” Alice Hamilton Exploring the Dangerous Trades Page 114.

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14 “At the time I am speaking of, Professor Charles Henderson was teaching sociology in the University of Chicago. He had made a study of German sickness insurance for the working class…which…made him eager to have some such provisions made in behalf of American workmen. The first step must be…an inquiry into the extent of our industrial sickness…Governor Deneen was…persuaded to appoint an Occupational Disease Commission, the first time a state had ever undertaken such a survey…Henderson had some influence in selecting the members and as he knew of my great interest in the subject, he included me in the group of five physicians…who made up the Commission.” Alice Hamilton Exploring the Dangerous Trades Page 118

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16 “We were staggered by the complexity of the problem… and we soon decided to limit our field…to the occupational poisons, for at least we knew what their action was, while the action of various kinds of dust and of temperature extremes and heavy exertion, was only vaguely known at the time. Then we looked for an expert to guide and supervise the study, but none could be found and so I was asked to do what I could as managing director…, with the help of twenty young assistants, doctors and medical students and social workers…” Alice Hamilton Exploring the Dangerous Trades Pages

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19 Industries Surveyed by Alice Hamilton for Occupational Disease or Injury Lead Metal Smelting Stone Cutting Munitions Manufacturing Copper and Mercury Mining Use of Benzene Solvents Viscose Rayon Manufacturing Radium Dial Painting (in collaboration with others)

20 …I visited forty-one plants in which all sorts of explosives are made…There were only twenty-eight factories from which trustworthy data could be secured, and I found that in those twenty-eight there had been in the preceding year a little more than 2,500 cases of industrial poisoning with fifty-three deaths. I am quite sure that this figure is less than the truth, for many cases fail to be recognized by the ordinary practitioner. Alice Hamilton Industrial Poisons Encountered in the Manufacture of Explosives J. Am. Med. Soc., May 19, 1917.

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22 …someone had told me the fumes in the tank house were worse at night. I am not a very courageous person and that visit was…an ordeal. It began with a climb in the dark up to the third story …on a sort of glorified ladder running up the outside wall, with open treads and a high hand rail on one side only...The acid was in enormous tanks and I was escorted around them on a narrow path…only a hand rail between me and that evil-looking, dark, bubbling acid, and I had the feeling all the time that if I stumbled I could so easily slip under the rail and plunge into the acid … Alice Hamilton Exploring the Dangerous Trades Pages

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24 My last detailed study of a poisonous trade was made in , when after many fruitless attempts I found it possible to explore an important but little-known industry…which was using an old poison,…carbon disulphide. There are few industrial diseases which move one’s sympathy more…The first two cases I saw, one of slowly developing paralysis of the legs, the other of rapidly developing manic-depressive insanity, made a deep impression on me…The study started in Pennsylvania and…then was extended to the other rayon producing states, Massachusetts, Rhode Island, Connecticut, New York, Ohio, Virginia, West Virginia, North Carolina, Tennessee….during the following three years changes in this industry came more rapidly and completely than any in my previous experience. Alice Hamilton Exploring the Dangerous Trades pp. 387,389,

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26 During the fall of 1918,…Dr. David Edsall, Dean of Harvard Medical School…asked me if I would come to Boston in April and give three Cutter lectures to the Medical School. My astonishment can be imagined for Harvard was then – and still is – the stronghold of masculinity against the inroads of women…Of course, I was both pleased and proud to accept…,but before I left for Boston the Cutter Lectures had come to seem almost unexciting compared to the much greater event of my appointment to Harvard as assistant professor of industrial medicine/ Alice Hamilton Exploring the Dangerous Trades Page 252

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28 “ Harvard had not changed her attitude toward women…yet here she was putting a woman on the faculty. It seemed incredible at the time, but later on I came to understand it. The Medical School faculty, which was more liberal…than the Corporation, planned to develop the teaching of preventive medicine and public health more extensively than ever before. Industrial medicine had become a much more important branch during the war years, but It still had not attracted men, and I was really about the only candidate available.” Alice Hamilton Exploring the Dangerous Trades Page 252

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30 To Frederick C. Shattuck December 9 th 1919 “My dear Dr. Shattuck: You will remember that I promised to think over very carefully the things you said to me last Monday…I cannot write you what…you wish to hear from me…of my relation to Harvard University and its bearing on my espousal of an unpopular cause…What I have said in public about… the Germans…I cannot…give up because of the prevailing feeling against Germany…it would be impossible for me to enter into any relation with any institution…if by so doing it was necessary…to detach myself…and take no part in questions…of the deepest importance to me… Sincerely yours Alice Hamilton” Sicherman, Barbara Alice Hamilton: A Life in Letters Page 248

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32 To Herbert Brownell, U.S. Attorney General May 16, 1953 …In your…”Petition” you accuse the Committee for the Protection of Foreign Born…of consistently supporting the views and policies of the Communist Party…Surely you do not think that it is only Communists who hold such views...Is it your rule that a cause in which one believes, must be avoided because the Communists also believe in it?... Sincerely, Alice Hamilton

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39 Since 1912 the Cutter Lectures on Preventive Medicine have been one of the most respected institutionalized lectures in the fields of preventive medicine and epidemiology. These lectures are administered by the Department of Epidemiology at the Harvard School of Public Health under the terms of the bequest from John C. Cutter, M.D. who specified that the lectures should concern preventive medicine, should be delivered in Boston, and should be free to the medical profession and the press. Close to 150 lectures have been given in the series. Alice Hamilton was the first woman to lecture in the series, giving three lectures in 1919.

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41 During the 25 years following the completion of the “Illinois Commission” survey, Alice Hamilton identified health problems related to metal smelting, stone cutting, munitions manufacturing, copper and mercury mining, use of benzene solvents, viscose rayon manufacturing, and (in collaboration with others) radium dial painting.* * Winkelstein W., Jr. Vignette: Alice Hamilton: Pioneer Occupational Epidemiologist. Epidemiology 2006;17:591

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44 Re: Sacco-Vanzetti Case: …There were frantic last-minute efforts to bring about at least a commutation of the sentence…Mr. Moors had secured the Governor’s consent to see us…It was a painful experience, quite hopeless from the first…The Governor was deeply angered, his face was flushed, he was hostile and clearly had no patience to listen to us…We got nowhere,…our words did not touch him… Alice Hamilton Exploring the Dangerous Trades Pages

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