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Alice Hamilton's groundbreaking epidemiologic studies investigating the occupational exposures of workers to poisonous substances used in manufacturing were critical to the development of the field of industrial toxicology and epidemiology. Hamilton's work contributed to the development of regulations enforcing healthier conditions in America's workplaces. Her career powerfully illustrates how epidemiologic research can stimulate and inspire scientific inquiry to serve the public good.

Hamilton was born in 1869 to a close-knit, patrician family in Fort Wayne, Indiana. Trained as a physician in the medical department of the University of Michigan, she joined the faculty at the Woman's Medical School of Northwestern University in Chicago as professor of pathology in 1897. For 22 years, Hamilton was a resident of Hull House, a famous American settlement in Chicago founded to connect the privileged classes and the socially disadvantaged, and this experience cultivated her interest in service and activism. She found her life's work in 1910, when she was invited to lead a state-funded study of industrial diseases, the first large-scale study of this type. She went on to conduct epidemiologic research of industrial diseases as a special investigator for the federal Bureau of Labor from 1911 until her final report in 1940 (see Table 1).

In 1919, Hamilton became Harvard University's first woman professor when she was invited to join the newly created Department of Industrial Hygiene at Harvard Medical School, a position she held until her retirement in 1935. Her professional work in public health continued until she was 80, and a new edition of her textbook Industrial Toxicology was published in 1949. Three months after Alice Hamilton died at age 101 in 1970, Congress passed the Occupational Safety and Health Act.

A Research Example: Lead Poisoning in Pottery Trades

Hamilton's monograph, ‘Lead Poisoning in Potteries, Tile Works, and Porcelain Enameled Sanitary Ware Factories,’ exemplifies her use of many modern epidemiologic principles, including the influence of case ascertainment and methods of comparing susceptible groups. The report documented her investigation of 68 potteries and factories in nine U.S. states. Information was collected directly from physicians, hospital records, personal inquiries, and examinations. The investigation identified industry practices that increased risk of lead poisoning and compared male and female prevalence of lead poisoning.

Table 1 Selected Monographs Authored by Alice Hamilton for the Bulletin of the U.S. Bureau of Labor Statistics
Year PublishedIndustry PrincipalExposure(s) Studied
1912Potteries, tile, and porcelainLead
1913PaintingWhite lead
1914Lead smelting and refiningLead
1914Battery manufactureLead
1915Rubber industryLead, antimony, benzene
1917Explosives industrNitrous fumes, TNT
1917Printing tradesLead poisoning, wood alcohol
1918Stonecutters“Dead fingers syndrome”
1921Coal tar dyes and dye intermediatesAniline, nitrobenzene, toluene, xylene, inorganic compounds (e.g., hydrogen sulfide, hydrogen arsenide)
1922Steel manufacturingCarbon monoxide
1940Viscose rayonCarbon disulfide, hydrogen sulfide

As part of the study, Dr. Hamilton identified 18 cases of lead poisoning that occurred in 1910 and 1911 among 314 men employed in Trenton, New Jersey, for a 2-year cumulative incidence of 1 in 31, and compared that with the prevalence in East Liverpool, Ohio, where of 480 men, 31 cases were found in the same time period, or 1 in 15 to 16 employed. (The terminology 2-year cumulative incidence is used here for clarity. Dr. Hamilton simply reported these as ‘ratios’ or ‘per cents.’)

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