We are fascinated by outliers.
In mathematics, an outlier is defined as “a value that ‘lies outside’ (is much smaller or larger than) most of the other values in a set of data.”
When it comes to applying this delightful word to human beings, we find the Cambridge Dictionary definition to be the best: “a person, thing, or fact that is very different from other people, things, or facts, so that it cannot be used to draw general conclusions.”
Alice Hamilton, M.D. was a splendid American outlier, and one of our very favorite Americans ever.
Alice Hamilton was born on February 27, 1869, in Manhattan. Raised in Fort Wayne, Indiana, she was the second eldest of five children. Sisters Edith and Margaret became scholars and educators; Nora, an artist. Her brother Arthur also became an educator. He was also the only sibling to marry; he and his wife Mary had no children.
In their youth, the Hamilton girls attended Miss Porter’s Finishing School for Young Ladies in Farmington, Connecticut, which still exists today, albeit in an evolved form. Education was of paramount importance in the extended Hamilton family. Edith once described their father thus: “My father was well-to-do, but he wasn’t interested in making money; he was interested in making people use their minds.”
After a year of studying science back in Fort Wayne, Alice enrolled in the University of Michigan Medical School in 1892. It was certainly no easy task for a woman to gain acceptance to medical school in those days. Yet even in 1892, there were precedents. Here, from the University of Michigan website, we learn of its very first female graduate:
Dr. Amanda Sanford was the first woman to earn a M.D. degree from the University of Michigan Medical School, graduating with highest honors in her class in March 1871. Her graduation thesis, “Puerperal Eclampsia,” was a thorough review of the state of knowledge at the time about this dire obstetrical complication and included some original research as well as statistics and case studies. Former faculty member Henry F. Lyster, addressing the graduating class, honored her by saying,“It is my pleasing duty to welcome to the profession a woman coming from these halls.” Some young men threw paper at her from the gallery during Lyster’s address, but she maintained her composure and became even more determined in the cause of women’s rights.
After earning her medical degree in 1893, Alice and her sister Edith traveled to Germany to further their studies, Alice in bacteriology and pathology.
In 1897 Alice moved to Chicago, accepting an offer to become a professor of pathology at the Woman’s Medical School of Northwestern University. She became a resident and member of Hull House, the Settlement House founded by social reformer Jane Addams. (The Settlement Movement was asocial movement that aimed to bring the rich and the poor of society together in both the physical and social senses; the goal was to transfer knowledge and life skills to the poor, and thus alleviate poverty.)
In her work with the working poor of Chicago, many of whom were immigrants, Alice came to define the “dangerous trades” as those which exposed workers to specific occupational diseases, diseases that could not be explained by factors outside the workplace. Lead poisoning was one of the greatest problems she identified; lead was used in the manufacture of thousands of items, from paint to bathtub enamel to solder to early batteries. At the time, industrial medicine was not being much studied in America. Alice contributed her first of many scientific papers to this discipline in 1908.
In 1910, Illinois governor Charles S. Deneen appointed Alice as a medical investigator to the newly-formed Illinois Commission on Occupational Diseases. In time, this Commission’s report, the “Illinois Survey,”authored by Dr. Hamilton, led to the passage of the nation’s first worker’s compensation laws and occupational safety laws in Illinois in 1911.
Dr. Hamilton was by now recognized as America’s leading authority on lead poisoning. In 1919, she was hired by the Harvard Medical School in the newly-formed Department of Industrial Medicine. Though her title was assistant professor, the Department was essentially founded around her. Yet at Dr. Hamilton’s request, this was a one semester per year appointment, which allowed her to continue her work for government agencies, and to continue to live at Hull House for half of each year. Throughout the 1910s and 1920s she investigated a wide array of occupational safety problems for various state and federal health committees. She described her work as “shoe leather epidemiology,” in which she combined personal visits to factories, interviews with managers and workers, and rigorous analyses of medical histories and case studies of diseased workers. Her efforts—rigorous, scientific and persuasive—influenced reforms and helped to bring about major gains in worker safely legislation and infrastructure, both local and nationwide.
The most remarkable thing about all the positive change Alice Hamilton created is that in no case did she have any actual authority to do anything. She served on government committees, but no powers of enforcement of any laws were given to her by any government, state or federal.
How, then, could she possibly be so effective, when the industrialists who ran things could simply ignore her at will?
Ah, this is where the core of Alice Hamilton’s outlier abilities came into play. Seen through the hazy distance of so many years, in an era long before conversations and meetings were commonly recorded in sight and sound, we cannot know with precision what it was like to engage Dr. Alice Hamilton in a one-on-one conversation—much less an adversarial one. Yet we are graced with her own words, as we are fortunate that she wrote a memoir in 1943.Let us then turn to those words and see if we can glean insights into how she wielded so much influence.
“Our procedure in the Illinois survey and in the work that I carried on later for the Federal government was completely informal. We had no authority to enter any plant, we had no instructions as to which we should visit, we simply explored the state.When we found a place which seemed to belong to our field, we asked permission to enter it. Never were we refused, never did I, at least, meet with anything but courtesy in those very early days. Sometimes it was because the manager was proud of his plant and eager to show it (even when it was outrageously bad); sometimes it was because he had a strong suspicion that all was not well with his men and he really wanted more light. As to the way we should deal with the conditions we found, that was a question for each of us to settle. The Illinois Commission expected me to report back to it and in such a way that no factory described in the report could be identified. That I did, of course, but I could not feel that my whole responsibility was thereby discharged. I was the only one who had seen the men working on the Scotch hearths in the smelters,emptying the baghouse and flues, sandpapering the lead-painted ceilings of Pullman cars, shoveling the white lead from the drying pans. How could I hope that a cold, printed report which would satisfy the Commission would serve to do away with these pressing dangers? There was no use in going to the factory inspectors: they were ignorant and powerless.
So, from the first,I made it a rule to try to bring before the responsible man at the top the dangers I had discovered at his plant and to persuade him to take the simple steps which even I, with no engineering knowledge, could see were needed. As I look back on it now from this changed world of “safety first,” expert factory inspection, the National Safety Council, industrial insurance companies, strict compensation laws, it astonishes and amuses me to see how very well this primitive method often worked.”
Here is one example—one excellent example of how Dr. Alice Hamilton worked her persuasive magic.
“Even more important reforms followed my contact with the National Lead Company which had several white-lead and lead-oxide works in and near Chicago. I visited them and found much dangerous work going on in all of them. One of the vice-presidents, Edward Cornish, later president, came to Chicago and I went to see him in the Sangamon Street Works. He was both indignant and incredulous when I told him I was sure men were being poisoned in those plants. He had never heard of such a thing; it could not be true; they were model plants. He went to the door and shouted to a passing workman to come in. ‘Did the lead ever make you sick?’ he demanded. The man, a badly scared Slav, stammered, ‘No, no, never sick.’ ‘Any other men sick?’ demanded Mr. Cornish. ‘No, no, all good,’ and the poor man escaped quickly. ‘There,’ said Mr. Cornish, ‘you see!’
‘But I do not see,’I answered. ‘Your men are breathing white-lead dust and red lead and litharge and the fumes from the oxide furnaces. They are no different from other men; a poison is a poison to them as it is to any man.’
He thought a moment and then he said, ‘Now, see here. I don’t believe you are right, but I can see you do. Very well then, it is up to you to convince me. Come back here with proof that my men are being poisoned and I give you my word that I will follow all your directions, even to employing plant doctors.’
It was not an easy task I faced, tracking down actual, proved cases of lead poisoning among men who came from the Serbian, Bulgarian, and Polish sections of West and Northwest Chicago, and were known to the employing office only as Joe, Jim, or Charlie,with no record of their street and number! It meant digging up hospital records, for I had to be sure of the diagnosis, then a search for the home, and finally an interview with the wife to discover where the man had been working, for of course no hospital intern ever noted where the victim of plumbism had acquired the lead. Hospital history sheets noted carefully all the facts about tobacco, alcohol, and even coffee consumed by the leaded man, though obviously he was not suffering from those poisons; but curiosity as to how he became poisoned with lead was not in the intern’s mental make-up.
In the end I was able to present Mr. Cornish with authentic records of twenty-two cases of plumbism severe enough to require hospital care. He was better than his word. Beginning with the Sangamon Street works, he went on to reform all the plants in the Chicago region, and this meant dust and fume prevention, often by methods which had never before been worked out. There were no models to follow; the engineers faced new problems. As each was solved, Mr. Cornish sent the blueprints to the plants in other states and later on, when I visited these, invariably I found the same changes being introduced. I had told Mr. Cornish he could never fully protect his men unless he employed doctors to keep strict watch over their condition, to make at least a brief inspection of each lead worker once a week. He accepted this recommendation without protest and before our report was published there was a medical department in each plant of the National Lead Company in Illinois.
I have met many admirable men in industry throughout these thirty-two years, but my warmest gratitude and admiration goes to Edward Cornish.”
Such were the powers of human connection wielded by Dr. Alice Hamilton.
Perhaps the only significant harm inflicted by industrialists upon the American population that Dr. Hamilton could not prevent was that of leaded gasoline.
In the 1920s, automobile manufacturers were increasing the compression ratios in their gasoline-powered internal combustion engines,for two reasons: to increase fuel mileage, and to increase horsepower. The problem with this was engine knocking. Knocking means loud explosions inside the engine that frightened motorists and pedestrians and damaged the internal workings of the engines themselves.
Alfred Sloan was the President, Chairman and CEO of GM in those days. Engineer Charles Kettering was head of research at GM from 1920 to 1947. Kettering was the inventor of the electric starting motor and many other innovations that were key to the development of the automobile. Striving to solve the problem of engine knocking, Kettering assigned engineer Thomas Midgley to find an anti-knocking solution. They gave him a one-cylinder lab engine and let him try whatever he might.
Midgley first found that ethanol never knocked, even at high compression ratios. This was not an acceptable solution for two reasons: America did not have a sufficient ethanol producing infrastructure at that time, and using ethanol as fuel would have angered the main supplier of fuel for GM cars, Standard Oil.
Midgley then found that 10 % ethanol (much as we employ today) mixed with 90% gasoline would stop knocking just fine. The problem with this solution is that anyone could do it: there was nothing to patent that would stand to make GM a separate set of profits outside of what it was making from the production of automobiles.
What happened next leaves the realm of science and borders on farce.
Midgley started adding chemicals at random to the gasoline he fed into his one-cylinder lab engine. He tried this and that, organics and inorganics, large molecules and small, until one day he laced his gasoline with highly poisonous tetra-ethyl lead. And lo and behold, the knocking totally stopped.
Lead itself is the most poisonous non-radioactive element. In its tetra-ethyl form it is exceedingly dangerous. And yet a triumvirate of General Motors, Standard Oil and DuPont set out to manufacture gasoline laced with tetra-ethyl lead, marketed as “Ethyl” in order to avoid any negative connotations associated with the other word that should have made up its name.
At least 17 workers died in the early days of Ethyl’s manufacture, and many others were severely injured, in Standard Oil and DuPont refineries in Bayway and Deepwater, New Jersey. Bill Kovarik, PhD, who has researched this subject in depth, informs us, “One worker in Deepwater, a janitor, died because a small amount of TEL went through a hole in his shoe while he was sweeping up.”
And yet the worst of it all was the perfect mechanism that Sloan, Kettering and Midgley had devised for spreading one of the worst toxins known into Earth’s entire biosphere: the automobile tailpipe.
By 1929, there were 26 million gasoline-powered vehicles in the United States, 23 million of them passenger cars. Of course, this number would only grow. In the mid-1980s, when leaded gasoline was finally phased out,there were nearly 200 million gasoline-powered vehicles on American roads. From 1921 to the end of 1986, when leaded gasoline was largely phased out, all those millions of tailpipes provided a highly efficient distribution system for lead to be placed—irreversibly—into our environment.
Deadly product.
At the 1925 Public Health Service conference on the use of lead in gasoline, Dr. Hamilton and others testified against this use of lead and warned of the danger it posed to human beings, especially children, and to the environment. The scientists were unable to stop the industrialists however, and the government allowed Ethyl to be marketed without restrictions. Leaded gasoline was the main means of propulsion of commercial and passenger vehicles in most countries in the world from the 1920s to the 1980s and 1990s.
The protean damaging results of Ethyl can only be estimated with imprecision. In 1988, an EPA study estimated that over the previous 60 years, 68 million American children suffered high toxic exposure to lead from leaded fuels. Some neurologists have speculated that the lead phase-out allowed average IQ levels to rise by several points, since one of lead’s effects is to stunt intellectual growth in children. Further, in every country on Earth, rates of violent crime decrease dramatically at around twenty years after the phase-out of leaded gasoline. The “lead-crime hypothesis” states that lead poisoning degrades the development of childhood brains in ways that increase aggression, reduce impulse control, and increase the chances of affected populations committing violent crimes in adulthood.
Circling back to Thomas Midgley for a moment, the reason some assert that he was the most environmentally destructive individual organism in Earth’s history has to do with not only tetra-ethyl lead, but also with his other major “contribution” to chemistry: CHCs. Chlorofluorocarbons, like Freon, the refrigerants that are implicated in ozone depletion in the upper atmosphere, which leads to the greenhouse effect and the dangerous overall warming of Earth’s biosphere.
That twenty-year correlation between lead phase-out and a decrease in violent crime seems like something Dr. Alice Hamilton would be very interested in studying further were she alive today. Alice Hamilton was one of the finest, most effective citizens our nation has ever produced. While even she could not stop General Motors, Standard Oil and DuPont from bullying and bribing the U.S. government into allowing them to poison the Earth with lead, her accomplishments in the field of worker safety and public health were effective and far-reaching. Dr. Hamilton laid much of the practical foundation for the first federal labor laws in our nation’s history: the 1938 Fair Labor Standards Act.