DEPARTMENTS​
DIGITAL EXTRA
ED RUTKOWSKI​ is editor in chief of The Synergist. He can be reached at (703) 846-0734 or erutkowski@aiha.org.
In a survey last autumn, AIHA asked its members a simple question: who do you admire, and why? More than 150 responses identified dozens of highly regarded individuals, nearly all of them currently practicing IHs. But the person who received the most votes died 45 years ago and did not identify herself as an industrial hygienist. She is Alice Hamilton, whose long life of service to worker health ended a few months before passage of the 1970 Occupational Safety and Health Act. Hamilton was the foremost expert in industrial toxicology in the early 20th century. Her work, which she described as “scientific only in part, but human and practical in greater measure,” led directly to the profession we now know as industrial hygiene. The empathy and understanding that informed Hamilton’s technical expertise helped her identify with the workers she sought to protect and find common ground with company managers predisposed to question her findings of hazards in their facilities. But this wasn’t something that came naturally to her. Historian Barbara Sicherman’s Alice Hamilton: A Life in Letters shows the young Hamilton, as a medical student, struggling with what she referred to as “the human side of my work”; her awkward attempts to relate to patients contributed to a crisis of confidence. The watershed moment for Hamilton’s professional life was her work for the Illinois Commission on Occupational Diseases, which was formed in 1908. Hamilton assumed leadership of the study on lead and demonstrated her talent for what she called “shoe-leather epidemiology.” Through visits to factories and interviews with workers suffering from lead poisoning, she discovered that lead was present in the enamel paint they used to make bathtubs. Invited to witness the process, Hamilton observed no potential for lead poisoning. Later, though, she discovered that she had been allowed to see only the finishing; the entire process involved spreading a powder on a red-hot tub. Hamilton obtained a sample of the powder from the wife of a worker who used it to scour pans. Analysis revealed that it contained as much as 20 percent soluble lead. The Commission’s report, presented to the governor in 1911, was the first to correlate medical cases and hospital records with occupational diseases. Months later, Illinois passed an occupational disease law. Five other states soon followed suit.
Due to her stature as a prominent pacifist, advocate for social legislation, and contributor to the Settlement movement, Hamilton's life rewards study even by those unfamiliar with occupational health and safety.
From this success Hamilton’s method took shape: conduct careful study of an industrial process; obtain permission to visit a representative factory; observe the process; interview workers; present findings to management. This approach, in Hamilton’s words, required her to “go beyond the cold printed report.” Confident in her persuasiveness and managers’ willingness to listen to logic, she rejected public attacks, shaming, and threats. She almost always succeeded in winning reforms that benefitted workers.
During World War I, Hamilton investigated, on her own initiative, factories that produced explosives. This new industry was considered vital to the war effort, and methods for protecting workers had to be invented simultaneously with the industrial processes the workers were using. Hamilton’s autobiography Exploring the Dangerous Trades, available from AIHA, contains a terrifying description of men being exposed to chemicals at work and dying later that night:
The typical picture of nitrous fume poisoning was as follows: The man was exposed a short time to heavy fumes or several hours to moderately heavy fumes, which made him choke and strangle, but in the open air this would pass over and he would go home thinking nothing serious had happened, eat his supper and go to bed, then awaken after some hours with a sense of tightness in his chest and an increasing difficulty in breathing. If the fumes had injured only part of the lungs then oxygen might pull him through till the exudate was absorbed, but if he had breathed deeply . . . then he would have little chance, for all the lung tissue would be filled and he would “drown in his own fluids.”
Reflecting on the ultimately successful efforts to improve conditions in this industry, Hamilton later wrote, “It is good to have one cheerful feature in the dark picture of a return to barbarism.” By 1918 Hamilton had earned a reputation as the foremost expert on industrial diseases. That year she received an offer to join the faculty of Harvard Medical School. She turned it down partly because it would have required her to conduct a study of worker health in department stores, a problem that didn’t interest her. Instead, she went to Arizona to study the effects of vibration from pneumatic hammers on copper miners. Harvard amended its offer, removing the requirement for the department store study, and Hamilton accepted, becoming the first woman to serve on Harvard’s faculty. This short account can’t do justice to Hamilton’s accomplishments, which extend beyond the realm of worker protection. Due to her stature as a prominent pacifist, advocate for social legislation, and contributor to the Settlement movement, Hamilton’s life rewards study even by those unfamiliar with occupational health and safety. Those who make the effort will undoubtedly agree with Hamilton’s Aunt Phoebe, who wrote of Alice, “The more you see of her, the more wonderful you find she is.”
As part of AIHA’s 75th anniversary celebration in 2014, The Synergist produced a special supplement to its September issue that included an interview with historian and Hamilton biographer Barbara Sicherman; the full version of the interview is available as a podcast from the AIHA website. Sicherman is perhaps the foremost expert on Hamilton’s life, and the podcast is a valuable introduction to an intriguing, under-appreciated figure of American history.

Listen now: An Interview with Barbara Sicherman (MP3 audio, 35 MB)

Beyond the Cold Printed Report Admiration for a Pioneer
BY ED RUTKOWSKI, EDITOR IN CHIEF, THE SYNERGIST
What Kind of Near-miss Was Ebola? As I write this in mid-October 2014, Americans are still getting used to the new and scary risk of Ebola. Ebola fears led to a number of airline passengers being yanked off planes because they exhibited flu-like symptoms and had some connection, however remote, to Africa. So far they’ve all tested negative for Ebola. If that remains true, the number of such disruptions will soon decline precipitously. 
Are these events warnings that we should continue to take seriously, “casting a wide net” to reduce the odds of missing an actual Ebola case onboard? Or are they false alarms that we should learn to stop worrying about? Most experts, officials, and journalists say they’re false alarms. But that answer will change in hindsight if a traveler from West Africa ever infects some fellow passengers with Ebola.
Ebola also offers an object lesson in learned overconfidence. The discovery that two nurses were infected with the virus while treating an Ebola sufferer at a Dallas hospital raised many questions. Did the nurses breach PPE protocols? Were the protocols insufficiently protective in the first place? Is it realistic to expect healthcare workers to be 100 percent meticulous in following such protocols? 
One relevant fact: every nurse has considerable experience with breaches of infection control protocols that didn’t end in infection. And all too often the lesson learned isn’t that “We need to be more meticulous.” It is that “Infection control is pretty forgiving. Even when we mess up, it doesn’t usually do any harm.” Then along comes a much less forgiving pathogen, Ebola, and learned overconfidence becomes life-threatening.
Peter Sandman