The United States in the Early Twentieth Century

In the United States the medical community also narrowed its focus, which set back the study of occu­pational disease for a generation. Others outside of the medical community developed a broader concep­tion of the relationship between the work environ­ment and health.

In industrial sections of the United States, individ­ual physicians and state public health officials par­ticipated in reform movements for workmen’s com­pensation legislation, and John B. Andrews and the American Association for Labor Legislation led cam­paigns against such problems as lead poisoning and “phossy jaw” (necrosis of the jaw caused by exposure to phosphorus, as in the making of matches). But occupational disease was not yet seen as an intrinsic part of the mandate of public health.

It was only in 1915 that the U.S. Public Health Service was granted authority to investigate “occu­pational diseases and the relation of occupations to disease.” It organized an Industrial Hygiene and Sanitation section, and shortly thereafter the Ameri­can Public Health Association also formed its own Industrial Hygiene section. In addition, a few of the state departments of health took an active and sustained interest in occupational diseases, most notably in Ohio under the leadership of Emery R.

Even those reformers and physicians who were concerned with diseases of occupation focused mostly on acute poisonings, especially heavy-metal and phosphorus exposure. In the early years of the twentieth century, such investigators as Alice Hamil­ton, Florence Kelley, Andrews, and Hayhurst car­ried out detailed studies of lead, phosphorus, and mercury in such states as New York, Illinois, and Ohio. In 1911, following the tragic Triangle Shirt­waist fire in New York, in which scores of immigrant women were killed, the state sponsored a massive study of factory conditions led by Robert Wagner and Frances Perkins, among others. In the 1920s and after, industrial hygienists and occupational physi­cians investigated chronic diseases in workers in a number of occupations, especially painters and bat­tery workers exposed to lead, watch-dial makers ex­posed to radium, and miners exposed to coal, silica, asbestos, and other dusts. The problem of lead had been known since antiquity, but the widespread in­troduction of lead into paint and gasoline and the increased smelting of ores associated with the Indus­trial Revolution heightened the awareness of the danger of lead to workers and the public alike.

During the early 1920s, workers in various petro­chemical plants and research centers developed signs of acute lead poisoning. This alerted the public health community to the potential environmental damage that the recently introduced leaded gasoline posed. The Workers’ Health Bureau argued that oil refinery workers were being “used like canaries in the coal mines” to test for the presence of poisonous substances. A major national conference was con­vened by the U.S. Public Health Service to discuss public policy regarding the use of organic lead in gasolines. However, it was not until the late 1960s and early 1970s that systematic efforts were made to eliminate lead from both indoor paint and gasoline.

It was also in the 1920s that women who worked in factories producing luminous watch dials in New Jersey were found to have symptoms of chronic radia­tion poisoning.

Medical and public health interest in occupational diseases gave rise to new professions, such as that of industrial hygienist, and new specialties, such as occupational medicine. They were dominated in the 1920s by private companies, which supplied finan­cial support, research facilities, and even patients. Indeed, in the United States hundreds of corpora­tions hired their own physicians, nurses, and engi­neering and medical personnel as part of company welfare and health plans. But there were very few industrial agencies that were concerned with indus­trial health and only a few universities, such as Harvard, Yale, and New York University, organized departments that addressed industrial hygiene spe­cifically. Thus, the control of workplace hazards was in the hands of professionals associated largely with private industry and therefore was not really associ­ated with the broader perspectives of the Progres­sives and labor reformers.