2WIDER USE OF EXISTING KNOWLEDGE

It is not so easy to understand why we have so long been in ignorance on the subject, why American physicians and sanitarians, to whom all other questions of preventable disease are matters of the greatest interest, should for so long have neglected industrial plumbism, which their colleagues on the other side of the water had so effectively controlled. After all, it is a question for the public health men to solve.

—Alice Hamilton, 1914

When Alice Hamilton called on her colleagues in the American public health community to overcome their ignorance about lead poisoning so that they could move forward to prevent it, she came to them as a consultant to the newly established US Department of Labor (DoL). That is, she was neither an officer of nor an adviser to the nation's preeminent health institution, the US Public Health Service (PHS). Her affiliation was quite telling. That year, the PHS had moved to expand its work in the field of occupational health, an initiative that the service consolidated in 1919 with the creation of an Office of Industrial Hygiene and Sanitation. Yet Hamilton remained committed to the federal labor agency. Upon her retirement from Harvard in 1935, she spurned an offer of employment from the PHS and instead resumed her consulting work with the DoL. As a stalwart partisan for workers’ health, Hamilton sided with the group she considered more likely to act forcefully.¹

Highly respected and richly networked, Hamilton had the social and cultural capital to cross and disregard bureaucratic lines of division. But she stood out as remarkable, if not unique, in that capacity. Throughout the three decades of her consulting career, recurrent battles raged between heath and labor agents at the state and federal levels of government. The crucial engagement that commenced in 1935 has received the careful attention of the historians David Rosner and Gerald Markowitz. These scholars have captured the key distinction between the unabashedly proworker advocacy stance taken by the DoL and the more cautious focus on impartial research adopted by the PHS. The circumscribed purpose here is to explore the implications of this jurisdictional dispute for the availability of occupational health hazard information for workers themselves and their representatives. In exploring these implications, it will be advantageous to examine the history of bureaucratic conflict prior to the New Deal period that began in 1933 and to illuminate the ways that the conflict played out at the state level. The fresh infusion of resources to combat occupational disease provided in the Social Security Act decisively shaped policy and practice in the field for decades to come, but it did not represent a federal takeover. State-level actors remained critical in promoting or constraining the creation and flow of knowledge about hazards. Over the course of this period, proponents of expanding workers’ access to information to a more significant extent cast their proposals and demands in terms of rights.²

The early involvement of the PHS with occupational and work-related disease was reactive. It was also belated. Although by the 1910s the United States had been engaged in intense industrialization for almost a century, the PHS and its predecessors had done almost no work in that area over that long time. Shortly after its birth in 1910, the US Bureau of Mines (BoM), which had no medical staff, asked the PHS for assistance. The bureau and the service forged what proved to be a durable partnership under which the latter assigned officers to conduct investigations in the extractive sector. Beginning with Special Investigator Samuel Hotchkiss's foray into western coal- and metal-mining districts in 1911, the PHS mounted a series of studies in the 1910s. The most important of these addressed the silicosis plague in hard-rock mining. The reports issued under PHS-BoM joint auspices introduced themes that would continue to be central to its messaging for the next three decades. In a presentation to the American Association for Labor Legislation (AALL) in December 1911, Hotchkiss declared, “Consideration of the subject of occupational diseases cannot confine itself to diseases distinctly attributable to the hazards of occupation. It must of necessity include a much broader field.” Thus, Hotchkiss took only passing notice of silicosis, coal workers’ pneumoconiosis (which he called “anthrocosis”), and lead poisoning and instead devoted attention to nonoccupational disorders like typhoid fever and hookworm disease. However admirable such breadth of vision might be in a general sense, in this context, it served to perpetuate inattention to a matter that had not received adequate scrutiny. What would sometimes become almost a perverse determination to trivialize the ostensible subject of inquiry appeared at the very outset.³

A second early theme that would become a prominent refrain was an inordinate emphasis on the role of miners’ personal hygiene and other behavior in disease prevention. In line with views expressed by numerous other sources during the Progressive Era, PHS representatives dwelled on the responsibility of the individual to prevent disease by his or her own action. Here again, a valid truism was deployed with good intentions but with the unfortunate effect of undercutting the importance of more appropriate and systematic preventive measures. In 1916, at the first meeting of the American Association of Industrial Physicians and Surgeons, Joseph Schereschewsky encouraged attendees to assist employees who too often exhibited “indifference, neglect, or ignorance” in maintaining their own health. Schereschewsky held that company doctors were “able powerfully to influence and promote the education of workers in matters of personal hygiene.” This claim elicited a skeptical response from George Price of the garment workers’ Joint Board of Sanitary Control. Drawing on deep experience, Price warned that “education by the industrial physician is looked upon by employees with some distrust.” In his report on health promotion in steel mills, James Watkins echoed his colleague Schereschewsky in suggesting that company doctors teach personal hygiene. However, Watkins provided not only a model pay-envelope insert that told steelworkers to “cut out the booze” but also another on the value of wearing respirators to limit inhalation of harmful dusts on the job. Others in the federal health service pointed out ways to curtail defective habits and to replace them with self-protective ones to reduce occupational health hazards. The team that observed pottery workers recommended a long, detailed list of behavioral changes to help prevent lead poisoning—what, where, and, how to eat and drink before, during, and after their shifts; removal of beards and trimming of mustaches; washing of hands and face. During their study of the severe silicosis epidemic around Joplin, Missouri, the PHS surgeon Anthony Lanza and coworker Edwin Higgins gave talks to groups of zinc-lead miners “with emphasis upon the fact that, regardless of any rules or regulations in force, their salvation from pulmonary diseases rested largely with themselves,” not with their employers, who could install engineering controls such as mechanical ventilation and water-fed drills.⁴

Although PHS guidance regarding workers’ habits did address the control of occupational hazards to some extent, it more often dealt with nonoccupational risks. Lanza and the BoM sanitary engineer Joseph White in 1916 produced a short pamphlet, How a Miner Can Avoid Some Dangerous Diseases, that concentrated heavily on avoidance of germs and filth outside the workplace. This BoM pamphlet devoted little space to facts about the respiratory hazards associated with underground exposure to airborne mineral particles. The cursory treatment of the dust threat alerted readers to the risk of tuberculosis and pneumonia but negligently not to the risk of any form of pneumoconiosis. Adding insult to obliviousness, the pamphleteers advised that “a great deal, if not most, of the dust breathing is due to the carelessness on the part of the miner himself.” Lanza and White thus reached a sort of perverse synthesis that combined a “big-picture” diversion from occupational disease with a victim-blaming exercise. Beginning with the mobilization for World War I and continuing thereafter, the PHS also devoted much of its attention to warning workers about the debilitating effects of sexually transmitted diseases.⁵

Unlike its cooperation with the mining bureau, no amicable division of chores characterized the relations of the PHS and the federal cabinet-level labor agency established in 1913. The new DoL quickly took steps to attack the challenges of workplace injuries and illnesses in the world's leading industrial economy. Its immediate predecessor, the US Bureau of Labor, had helped to address the epidemic of phosphorus poisoning afflicting employees in the friction-match industry. Within months of its elevation to departmental status, the labor agency's congressional supporters moved to give it a Bureau of Labor Safety. Although focused on the more prominent problem of traumatic injuries, the proposed legislation also authorized the DoL to study occupational diseases and disseminate information on this subject. As the historian Christopher Sellers has observed, this initiative jolted the PHS into much-increased action in the field. The two bills introduced in the House of Representatives to authorize this new bureau triggered a territorial contest that would continue until midcentury. In February 1914, Byron Newton, assistant secretary of the Treasury Department, within which the PHS was located, informed both the Secretary of Labor and the Senate of his opposition. Newton contended that his department had jurisdiction over this problem and the expertise to deal with it. Any DoL program would be an inefficient duplication of effort. At House hearings, advocates for the Bureau of Labor Safety proposal maintained that they envisioned this body serving as a clearinghouse for information on occupational disease. Representative Robert Bremner, sponsor of one of the bills under consideration, asserted that “education is the key to occupational health.” The PHS had staked out its claims to authority based primarily on its superior investigative abilities, not its capacity to distribute health information. Hence, it was conceivable at this juncture that the public health agency might confine itself to the scientific research function that it deemed most central to its identity and legitimacy and leave the less-valued function of spreading information to labor agents. Instead, the PHS took a hard line, foreshadowing the rivalry to follow. After passage by the House, this proposition died in the Senate. The Public Health Service had won the first round of the fight.⁶

Federal public health officials endeavored to differentiate themselves from their labor-affiliated rivals by claims of impartiality and objectivity. Whether located in the public sector or the private sector, health professionals, many of whom imagined that they held unique capabilities and opportunities to mediate class relations, commonly took this stance in the early twentieth century. PHS investigators rationalized their unwillingness to divulge the diagnoses of workers observed in field studies by reference to a dedication to impartiality. By 1917, the organization had adopted the policy of not providing examination results to those examined or to their employers. Among other ventures involving mass screening of workers, in two major investigations in the coal industry—one in bituminous fields in the 1920s and another in the anthracite region in the 1930s—the PHS followed this secretive approach. Yet inconsistencies occasionally cropped up during early projects. In its 1918 inquiry in the pottery industry, a project in which more than 1,700 workers received examinations, the PHS did inform those with lead poisoning of their diagnosis and advised them to see a physician of their own choosing. The government physicians kept this information from employers. The pottery workers’ case may have been a unique exception, a consequence of the cordial relations between the employers’ trade association and the workers’ union, the National Brotherhood of Operative Potters. One of the agency's consultants apparently did not believe that such a policy should apply to private parties. Based on his PHS-commissioned survey of 170 industrial firms, C. D. Selby encouraged company doctors attending the 1918 meeting of the National Safety Council to be forthcoming with employees who had undergone workplace examinations. Selby suggested that merely making the effort to share findings would be appreciated by patients. These inconsistencies notwithstanding, the determination of the federal health authority to create for itself a strong identity as an investigatory enterprise gave it an imperative to gain access to research subjects, a privilege that employers could easily deny if they feared that diagnostic evidence could be used against them.⁷

Federal interagency conflict was minimal over the two decades following the defeat of the proposals for a safety and health unit based in the DoL in the mid-1910s. A brief truce held while the DoL operated a Working Conditions Service with PHS assistance during World War I. Even this moment of cooperation occurred only after a failed takeover gambit by the health officials. In the postwar decade, revived efforts to place a safety division in the DoL went nowhere. In expressing opposition to an initiative in 1926, Department of Treasury and PHS leaders contended that they had the problems of occupational disease so well in hand that nothing but wasteful duplication would result from any labor intervention. Secretary of the Treasury Andrew Mellon conceded only that the DoL had a right to deal with traumatic injuries. Defenders of the PHS at this moment again emphasized its function of collecting scientific data, not that of warning workers at risk.⁸

The early days of the New Deal witnessed another moment that illuminated the contrasting orientations of the rival agencies. In February 1934, the Bureau of Labor Statistics offered the committee drafting health and safety provisions for codes of fair competition for the National Recovery Administration a right-to-know proposition for the manufacturing sector. The proposal set this requirement: “All employees shall be instructed in the hazards incidental to the work engaged in, both in regard to the individual and to fellow workers.” The short-lived recovery agency apparently never incorporated this radical right into any of its many codes governing an industry or trade. Nonetheless, mere consideration of this audacious proposition represented a suggestive commitment to the principle of transparency.⁹

During the quarter century after 1910, the occasional interventions from any administrative source in Washington remained marginal compared with the work undertaken on an ongoing basis by public agencies of the industrial states. Following the pathbreaking investigatory surveys in Illinois, New York, and Ohio, numerous systematic efforts to come to grips with the emergent issue of occupational disease occurred at the state level of government. New York led the way in building institutional capacity and using it. Of most relevance here, the New York Department of Labor (NYDoL) devised an influential policy of democratizing access to health hazard knowledge and other information related to occupational disease. In this early phase of government action, no two states followed exactly the same path, however. The New York model was hardly hegemonic. An alternative system arose in neighboring Connecticut that bestowed authority on the state's health, not labor, officials and pursued a more restrictive approach to the generation and transfer of information. The divergent patterns forged in New York and Connecticut would each offer definitive guidance for the DoL-PHS rivalry after 1935.

From its founding in 1913, the NYDoL's Division of Industrial Hygiene (renamed the Bureau of Industrial Hygiene in 1924) led the way in promoting workers’ knowledge of work-induced health hazards and their adverse effects. Its parent department embraced as a priority its educational role in this area. In 1916, at the first major conference it sponsored, the department's second in command, James Gernon, discussed what he termed “the necessity for educating employers and employees.” Gernon posed the issue in emphatic terms: “There are ever changing industrial processes, many of which are productive of industrial hazards and diseases, in the wake of which follow thousands of instances of untold suffering and enormous economic loss. Much of this human waste can be prevented. Of industrial diseases we know far too little and here is offered a wide field for intelligent investigation and endless opportunity for educating all the people.” In cooperation with other departmental branches, the industrial hygiene unit produced and distributed posters, pamphlets, and other educational materials. Mass mailings of warning cards on the hazards of lead in English, German, Italian, Polish, Hungarian, and Yiddish went out in 1913 to all locals of the painters’ union in the state. By the mid-1920s, the division had added pamphlets for workers covering the risks associated with antimony, arsenic, wood alcohol, chromic acid, mercury, benzene, anthrax, and silicosis. Outreach efforts extended to presentations in workplaces, where a team of lecturers from the Section of Education deployed films, exhibits, and slideshows. In 1917, Lester Roos, one of the Division of Industrial Hygiene's medical inspectors, decried the disproportionate exposure of non-English speakers not only to lead but also to other toxic chemicals. “It is almost impossible to make them understand the dangers in the work in which they are employed,” Roos observed, “and it seems to me that something should be done along the lines of education.” In his view, this meant primarily promoting the teaching of English. In situations where they could surmount a language barrier or faced none, inspectors like Roos had opportunities to convey warnings orally. In 1923, the division used a radio broadcast to encourage working-class listeners to send in written questions about their occupational health hazards. While maintaining a focus on health threats in the workplace, the state industrial hygienists also issued guidance on general health matters like nutrition.¹⁰

Besides direct communication with at-risk employees, the Division of Industrial Hygiene and its associates elsewhere in the NYDoL attempted to prevail upon employers to assist in alerting their employees to the health risks they faced. Picking up on Dr. Loos's concern, state officials pressed managers to institute worksite language training for their non-English-speaking laborers. The industrial hygiene group urged managers to do more to instruct all their subordinates about the threats posed by substances like arsenic. In at least one major class of industries fraught with hazards, these urgings took some effect. In 1929, William Burke, a chemical engineer with the Bureau of Industrial Hygiene, found that chemical manufacturers were “becoming awake to the necessity of the proper education of the employees pertaining to the accident and health hazards.” Burke noted that prospective employees received notification of the risks they would encounter even before they accepted job offers. Both in its own publications and in selecting employer representatives to discuss their educational programs at annual conferences, the NYDoL publicized managerial best practices. A pamphlet on the health hazards in chemical manufacturing praised an unnamed firm that had adopted the red-disc warning symbol in its plant and that regularly placed instructive messages in English, Italian, and Polish in pay envelopes. One presentation at the department's 1919 safety conference extolled the use of educational movies by numerous prominent companies. Louis Dublin of Metropolitan Life Insurance Company told attendees at the 1924 conference, “Workers must be taught what dangers they must avoid in the course of their everyday employment. When they know more about the hazards of their occupation they will exercise greater care.” (Two years earlier, Dublin had published a widely distributed reference work, Occupation Hazards and Diagnostic Signs, which struck the same imperative tone: “Workers must be instructed as to the toxicity of the substance handled.”) Physician May Mayers of the Bureau of Industrial Hygiene advised company doctors and their superiors that “education of the worker to an intelligent understanding of the hazards to which he is exposed and their prevention is indispensable to proper cooperation between worker and industrial physician.”¹¹

New York's policy of openness extended to granting workers and their representatives access to data that it held. In 1911, when the state's lawmakers ordered physicians to report cases of selected occupational illnesses to the DoL, that statute placed no restrictions on the sharing of that information. This was also the nature of the legislation in other states in the first wave of such enactments. These laws used the template crafted by the AALL. That crew of Progressive reformers valued the creation of a corpus of evidence on the prevalence and incidence of occupational disease and its utility for government experts more than it valued transparency in making that database widely available to those directly affected. When the AALL joined with the National Civic Federation to study mercury poisoning in the New York metropolitan area (where an inordinate share of the victims were foreign-born workers), their 1912 report on the project looked hopefully to the process set in motion by the recent disease-reporting requirement: “Gradually a body of authoritative data will be collected, showing the conditions of health in the factories and demonstrating the process in industries which call for special regulation.” The AALL reformers soon recognized that company doctors were the key constituency for reporting cases and that diligent reporting by those practitioners would likely prove to be disadvantageous to their relations with their employers. Alice Hamilton saw that passage of a reporting law in Illinois had the perverse effect of causing doctors retained by firms with lead hazards to “refuse to admit that any but the most extreme cases are to be called lead poisoning.” Hence, the association changed its standard bill to add a clause that aimed to lower the resistance of physicians to submit reports. The 1913 version of the AALL model bill disallowed use of the reports in any legal proceeding. In short order, a number of states adopted into law this revised formulation, including some that retreated from their earlier laws.¹²

New York refused, however, to go along with this denial of transparency. When the state amended its requirements in 1913 to make brass poisoning reportable, it passed over an opportunity to make case reports inadmissible evidence. These reports to the NYDoL served to trigger inspections that gathered corroborating evidence of hazards, evidence that could prove helpful to sickened workers and their unions or lawyers. The state held out as the inadmissibility principle, blessed with an authoritative endorsement from the national group of state officials seeking uniform laws, become predominant after 1913. In a further move to facilitate just resolution of compensation claims, the New York Bureau of Industrial Hygiene made its laboratory services available in the 1920s at cost to physicians attempting to confirm diagnoses in lead-poisoning cases.¹³

The fullest expression of New York's dedication to expanding workers’ access to self-protective information came in January 1919 with the issuance of A Plan for Shop Safety, Sanitation and Health Organization. This booklet delineated a participative system that challenged the prevailing preoccupation with carelessness. Drawing on the experience of the innovative Joint Board of Sanitary Control in the garment industry, the state labor department criticized the inadequacy of a top-down approach and advocated giving rank-and-file workers a new active role: “The remedy is to educate and interest the worker in safe and sanitary practices. But signs and posters alone are inadequate. Success in such matters can best be attained with the cooperation of employees.” In this model, the key mechanism for achieving labor-management cooperation was the active participation of workers’ committees in creating and sharing hazard information and acting on this information to solve workplace problems. The committees, composed of members elected by their peers in the workplace, would be designated to receive hazard evidence from management and to discover additional facts on working conditions in their own inspections. They would use their knowledge to propose methods of disease and injury prevention. The extent to which New York companies adopted this innovative and daring approach is, unfortunately, unknown. Nonetheless, this proposal stands out as not only embodying a right to know but even pointing the way toward a right to act.¹⁴

Beyond their support for voluntary action by employers, New York labor administrators promoted dissemination of occupational health knowledge in at least one recommendation for regulatory change. In 1919 the Division of Industrial Hygiene visited 335 chemical factories, with the express aim of determining whether the state's code of regulations needed amendments. The investigators found a widespread lack of hazard knowledge among a vulnerable workforce in risky jobs. They urged the Industrial Commission to make a number of new rules. One suggestion in particular addressed the pervasive ignorance on the front lines of production: “In all places in which there are handled substances which are poisonous, or are dangerous to health or safety, it shall be mandatory for the employer to fully acquaint the employees with the nature and the properties of the materials being handled. This shall be done by means of posters, printed in the English language, and by verbal instruction when necessary.” Whether it became a casualty of the postwar recession or it was simply too radical, this recommendation did not find its way into the state's regulatory arsenal.¹⁵

Beginning in the 1910s, a number of other industrial states adopted an approach similar to that of New York, basing their occupational health programs in labor agencies and pursuing a policy of promoting openness in sharing information with workers. Developments in New Jersey mirrored those in New York State. At a 1916 symposium on occupational disease held by the American Chemical Society, Newell Gordon of the New Jersey Department of Labor chided employers who refused to divulge known hazards to their laborers. Gordon's department, aware of the findings from his study of conditions in the state's burgeoning munitions industry, stood willing to disseminate warnings but lamented its lack of funding to do so. Two events in the mid-1920s served to increase the agency's role in alerting at-risk workers. In 1924, New Jersey amended its workers’ compensation statute to add coverage for a number of occupational diseases. “Until this law was passed,” Andrew McBride, the state's commissioner of labor, observed, “it had been a common practice for employers to hire labor ignorant of the nature of the poisonous substances that were being handled and to give workers no more than a cursory, formal warning notice to take care of themselves.” The filing of compensation claims triggered investigations by his department, whose representatives gave managers warning notices to be posted and pamphlets to be passed on to those endangered. By 1928, according to McBride, his officers insisted that chemical plants “engage in a strict practice of industrial education for their workers and that this education be intensive and continuous.” The second event that illuminated the need to improve the flow of information was quite a dramatic one. The fatal intoxications suffered in 1924 by five Standard Oil of New Jersey employees who manufactured the fuel additive tetraethyl lead precipitated the distribution of warning notices by the state and requirements for advising workers about the hazard. In the wake of this disaster, Commissioner McBride declared that his inspectors were “required to see that these precautionary measures are strictly carried out.” Here, as in New York and elsewhere, the availability, at least in principle, of police powers of enforcement distinguished labor department methods from the softer approach generally taken by health officers. But the extent to which the inspectors strictly implemented that mandate is unclear and doubtful in chronically underfunded agencies.¹⁶

In Wisconsin, the dynamics of change resembled those that operated in New Jersey. During the 1910s, the state drew criticism from unions for its minimal intervention on work-induced illnesses. Then the enactment of workers’ compensation for all occupational diseases in 1919 precipitated a modest measure of reform in spreading protective information. In 1921, the state's Industrial Commission issued a general order compelling the disclosure of information. This order commanded that “the employer shall instruct all employees who are required to work where industrial poisons of a hazardous nature are used, stored, or carried regarding the danger connected with their work, the best preventative methods, and the measure for affording assistance to other employees when affected by such poisons.” The order was accompanied by a set of warning posters. These came with a warning to employers that “the mere posting of a warning poster is not enough” and that they “must do everything reasonably calculated to instruct their employees fully upon the hazards and the methods of prevention.” Both in its compensation reform and in this regulation, Wisconsin took a comprehensive approach, in contrast to the piecemeal, hazard-by-hazard strategy used in some other jurisdictions.¹⁷

In 1912, Massachusetts transferred the regulation of occupational disease from the Board of Health to a newly created Board of Labor and Industries. The board's lack of resources placed it in a weak position with regard to effecting compliance. This weakness was manifest in the very terminology used in its rules. In 1916, it promulgated “rules and regulations suggested” for advising workers about anthrax and benzene derivatives. In the guidance it offered employers on anthrax, the board set a solicitous tone: “You are urged to apply these suggestions in your establishment in so far as they are applicable to your special line of industry.” Shortly thereafter, the agency put out a poster on the dangers of anthrax, without any indication that its display was mandatory. The political-economic situation in this state clearly permitted only very limited, tentative exercise of government authority on what was then a regulatory frontier.¹⁸

When Pennsylvania created its Department of Labor and Industry in 1913, one of the original components was a Division of Industrial Hygiene and Engineering. By the following year, the division was distributing multilanguage posters devoted to the lead hazard. In addressing the problem of benzene, Pennsylvania's government labor officials insisted on the employer's duty to make subordinates aware of the risks associated with this toxic solvent. As munitions production accelerated with the mobilization for war in 1917, the Department of Labor and Industry required that explosives factories post warnings regarding hazards of acid fumes and asphyxiants. In the postwar period, Francis Patterson, the head of the industrial hygiene unit, proposed moving beyond circumscribed initiatives that dealt with one or a few hazards in a particular industry. At a 1922 conference put together by the PHS, Patterson declared that all workers should be warned about the occupational disease hazards of their jobs and advised how to avoid them. But in the conservative context of the 1920s, the state made no discernible progress toward this objective. In at least one significant instance, the Department of Labor and Industry failed to make available to endangered workers the data that it had gathered. In 1934, the department's Industrial Hygiene Section collected dust data and conducted medical examinations at four plants that made asbestos textiles. Although the examinations determined that one quarter of the employees had asbestosis, no individual received notification of his or her diagnosis. This practice blurred the line between the greater transparency that prevailed where labor officials held information and the opacity favored by their counterparts in health agencies. Like its counterpart in New York, the Pennsylvania labor department sponsored its own series of educational conferences, with those members of the medical profession specializing in occupational disorders as the primary audience. At a session in 1917, the ubiquitous Alice Hamilton called on company doctors to take the lead in educating workers about industrial diseases. Hamilton encouraged reliance primarily on oral messages delivered in the workers’ own language and suggested the value of using readily understood pictures.¹⁹

States in which regulation of occupational disease fell under the control of health agencies tended to follow more conservative policies generally and with regard to transparency specifically. Connecticut epitomized this more secretive approach. That state stood near the opposite end of the political spectrum from New York, which from the 1910s onward grew into a bastion of liberalism with an inclination to protect workers from a range of perils besides those of occupational disease. In contrast, Connecticut welcomed ruthless manufacturers fleeing New York's new limitations on sweatshop operations. Its factory safety inspection was notoriously weak. The conservative workers’ compensation law of 1913 accommodated manufacturers and the powerful insurance firms based in Hartford. The 1913 session of the state legislature also forbade the introduction of any physician's mandated report of occupational disease into “any action at law against any employer of such diseased person.” After occupying a gray area of overlapping jurisdiction between the Department of Labor and Factory Inspection and the Board of Health, the job of disseminating information on work-induced disease was assigned by statute in 1917 to a newly created Department of Health.²⁰

The Connecticut Department of Health set about controlling the flow of information. That physicians’ disease reports still went to the labor office for compilation prompted Commissioner of Health John Black and colleague E. K. Root to complain to the governor in 1919. Black and Root contended that, because the Department of Labor and Factory Inspection was “not prepared to consider the problems of industrial hygiene from a scientific point of view,” this function should be transferred to his department. Four years later, physicians’ case reports were redirected by the legislature to go to the health department. In 1927, that is, fourteen years after New York launched its Division of Industrial Hygiene, Connecticut established a Division of Occupational Diseases within its Department of Health. The department brought in physician Albert Gray, a PHS veteran, to run the unit. Under Gray's direction, the division's primary mission was investigatory, not informational. Modest information transfer activity targeted employers and the medical community and excluded workers. In recounting work done in the year that ended in mid-1930, Gray devoted thirty-one pages to technical studies and one sentence to educational activities. None of the division's recommendations to business management for remedial action dealt with giving at-risk employees any knowledge of their situation. During its initial decade of operation, the unit gave no evidence of having any working relationship with either organized labor or their fellow public servants in the Department of Labor and Factory Inspection. In its preoccupation with serving the needs of business organizations and professional groups, the Division of Occupational Diseases embraced the same adherence to a sort of corporatism without labor that Gray's former employer pursued at this time in its administration of the notorious Picher, Oklahoma, clinic in the Tri-State zinc-lead mining district and in its handling of the controversy over tetraethyl lead.²¹

Safeguarding the database of physicians’ case reports remained a concern in Connecticut. In 1929, by which time the state allowed workers’ compensation benefits for certain diseases, the legislature explicitly barred from the claims adjudication process any use of mandated physicians’ reports. The hallmark principle of secrecy was something to boast about. In his role as chair of the Industrial Hygiene Committee of the Conference of State and Provincial Health Authorities of North America, Stanley Osborn, Connecticut's health commissioner, used his annual report for 1929 to note his state's ability to avoid entanglement in the adversarial compensation process. R. L. Thompson of the PHS applauded Connecticut's stance. Thompson was acutely aware that at the end of the 1920s, only the health agencies in Connecticut, Ohio, and Michigan had authority over occupational diseases and that the activities in the latter two states were quite circumscribed. He delivered both encouragement and a warning to the conference of health officials: “Except for the excellent progress in industrial hygiene in the State of Connecticut, State Departments of Health seem to have entirely neglected this field of public health work. It is believed it cannot be too strongly recommended to the state health officers that unless they take steps to attach this work to their departments it will be located in Departments of Labor or Industry.” This exhortation only foreshadowed the promotional campaign that the PHS would mount in the coming years. In 1931, the Connecticut legislature further extended the unavailability of government-held information by blocking the admission of any data gathered in the course of a health department investigation of occupational disease as evidence in any lawsuit or compensation claim. As Gray fought in 1933 to maintain his operation, recently elevated to bureau status but under the stress of budget cuts amid the Great Depression, he emphasized that his organization provided confidential evaluations to many employers that could not be used against them. The contrast between the transparency guiding New York and the opacity across the state line could not have been starker.²²

The Great Depression set in motion developments that had a profound impact on the role of government in addressing occupational disease. Among the millions of workers displaced by the decade-long economic collapse were many impaired by work-induced illness. Desperate sick and disabled unemployed workers filed a flood of workers’ compensation claims and, more commonly, lawsuits for damages where state workers’ compensation did not cover disease. The carnage wrought by one disorder alone, silicosis, sent shock waves through the business community. Although examining the full breadth of this crisis is beyond the scope of this book, one reform that resulted from the pressures brought by the discarded members of the working class had a major blighting influence on the nature of public policy on the right to know, an influence that lasted for more than a third of a century.²³

As a sense of anxiety and even panic beset corporate leaders, those interested in containing losses from occupational disease saw the arrangements in Connecticut as a potential firewall. At its 1934 session, the Conference of State and Provincial Health Authorities heard the fears and desires of the insurance industry articulated by Wesley Graff, safety director of the National Bureau of Casualty and Surety Underwriters. As the representative of forty firms that wrote workers’ compensation policies, Graff noted the disturbing rate at which occupational-disease claims had risen in recent years. Without claiming that even one enterprise in any industry had actually failed thus far because of these claims, he asserted, “It is no exaggeration to say that the financial life of many of our most important industries is at stake.” Graff appealed to state health leaders to intervene and indicated his group's preference for their involvement over that of labor agencies. In his view, the state “should be kept clear of all legal entanglements” such as providing factual information relevant to compensation claims. He offered this more specific guidance: “The relation between the employer and such occupational disease bureau should be strictly confidential, so that the results of the bureau's investigation of any particular plant will be available only to the management of that plant.” Graff pointed to the success of this sort of arrangement in Connecticut. He assured his audience that his own industry was ready to help pass any legislation necessary. The conference's Industrial Hygiene Committee, still chaired by Connecticut's Stanley Osborn, lent its support. The committee urged that “definite provisions should be made that the results of investigations by the health department cannot be used as evidence in connection with any claim for compensation.” They repeated the contention that business enterprises would not use the state's expertise without that safeguard. In the assemblage's discussion of the Industrial Hygiene Committee's report, Roy Jones of the PHS reiterated his organization's well-known position and described the assistance that it had given to Connecticut in launching its program. The conferees voted to back the Connecticut model. In its annual report for the year ended June 30, 1934, the Connecticut Bureau of Occupational Diseases called attention to a recent similar endorsement from the American Public Health Association. Albert Gray gloated, “During the past year National and State Trade Associations, Insurance Institutes and Departments of Health in industrial states have displayed great interest in the method used in Connecticut for the administration of occupational disease control.” The state's status as the exemplar of conservatism had become well recognized.²⁴

By the mid-thirties, representatives of organized capital had another reason to favor Connecticut's system. One early initiative of the New Deal had raised the specter of a fuller commitment to the labor-based alternative identified with New York. Prior to his election to the presidency, Franklin Roosevelt was serving as governor of New York State. He brought with him to Washington his industrial commissioner, Frances Perkins, to serve as secretary of labor. In July 1934, Perkins set up a Division of Labor Standards (DLS) headed by Verne Zimmer, her former subordinate in the NYDoL. The primary aim of this new body was to expand federal involvement in the regulation of hazardous working conditions. Promotion of the New York model under federal auspices could become a nightmare for employers and insurers unwilling, and, in a depressed economy, perhaps simply unable, to bear the human costs of production.²⁵

Partisans of health department primacy had their prayers answered by Congress. After the American Medical Association killed an attempt to incorporate a state health insurance plan into economic security legislation, policymakers offered what was essentially a consolation prize in the realm of health affairs. Title VI of the Social Security Act, which became law on August 8, 1935, provided for federal grants to state and local health departments and for additional funding for the PHS to cooperate with state and local authorities in disease investigations. Although the act did not explicitly cite control of occupational diseases as an object of concern, at congressional hearings on the proposal, Surgeon General Hugh Cumming had identified this as a matter in great need of remedial action. Cumming assured the House Ways and Means Committee that, “as an impartial fact-finding body, [his agency's] investigations are accepted by the general public and by both labor and industry.” In anticipation of the passage of the security program, A. J. Chesley, secretary of the Conference of State and Provincial Health Authorities, predicted that soon there would be “a better chance for the development of occupational disease control by State departments than ever before.”²⁶

Chesley was right. With the dire budget constraints imposed by the protracted depression, the lure of federal money immediately induced many states to start, expand, or transfer programs. The PHS undertook a strenuous campaign to guide, train, and otherwise assist state-level officials, especially those just entering the field. Trainees who completed the service's seminar in Washington were sent to Hartford for an orientation to the flagship Connecticut program. Within approximately two years of the approval of the Social Security legislation, twenty-five state health departments were running or planning occupational health offices. In March 1936, Pennsylvania shifted its Division of Industrial Hygiene from the Department of Labor and Industry, leaving behind its coordination with compensation and enforcement activities there. Pennsylvania was participating in a mass exodus. Whereas in the 1920s, twenty-seven state programs were based in labor departments, by the late 1930s, only two remained in that institutional location.²⁷

To qualify for federal funding, states had to develop programs with an educational component. But under PHS tutelage and with the Connecticut example on display, these activities tended to be modest. They also targeted managers and health professionals, not at-risk workers. Information aimed at working-class audiences was often marginal or even irrelevant to expanding workers’ knowledge about occupational health hazards. Federal officials made available to their grantees a series of pamphlets for which a significant share of the topics chosen were subjects of general health—influenza; appendicitis; and, the perennial favorite, sexually transmitted diseases. This dispersion of focus only reinforced the preexisting orientation of state health agencies, which had long left occupational disorders at the margin.²⁸

The PHS maneuvered to instill the code of opacity in embryonic state systems. Rhode Island launched an industrial hygiene program in 1936 and at once conducted a hazard survey. This exercise determined that toxic substances threatened fully one-third of the workers in surveyed establishments. The fledgling Division of Industrial Hygiene in the Department of Public Health hastened to assure business owners who granted access to their premises that its study findings “were to be treated confidentially, and retained so.” This policy became entrenched for subsequent field investigations. The Rhode Island department believed that “such a procedure is advised by the U.S. Public Health Service and by various like agencies that have had meritorious experience in this work.” The department vowed to “jealously guard our vouched confidence.” In 1940, the PHS offered grantees a manual for administering statewide surveys, with the assurance that this procedural template had proven to be a successful and efficient one. The manual provided a form letter to use to gain access to worksites, which promised that data gathered “will be treated in such a confidential manner that no individual plant findings will be revealed.”²⁹

Federal consultants managed to attach to the reports of state survey findings recommended prescriptions for gathering and sharing investigative data and other sensitive information. When the Colorado State Board of Health made proposals for hazard control measures after their evaluative exercise (a study that encompassed the irrelevant phenomenon of “venereal diseases”), the PHS influence was evident. The roster of proposed preventive measures did not extend to any dissemination of information to workers at risk. The joint federal-state needs assessment in Utah yielded a similar list of suggestions devoid of any encouragement for delivering warnings or instructions to vulnerable workers. The report from Utah made clear that no findings regarding workplace hazards were divulged to those facing those hazards. This document advocated that recipients of periodic, employer-administered medical examinations be counseled about any nonoccupational disorders discovered. Another chance to normalize the barricading of information came when states pondered reforming their workers’ compensation laws to cover diseases. Where legislative changes were being contemplated, the PHS urged state health officials to seize the opportunity to sell their program to employers as a way to avoid potential outlays by assuring the impounding of sensitive data that might aid compensation claimants. In 1941, J. J. Bloomfield and PHS colleague W. M. Gafafer pointed to the arrangement that prevailed in their recent Utah project: “It was decided that all records obtained in the study were to become the property of the Public Health Service, and that all information would be strictly confidential.” Bloomfield and Gafafer noted that this strategy had led directly to both the successful formation of a permanent industrial hygiene office in the Utah State Board of Health and the enactment of compensation for selected occupational diseases. Appearing in Public Health Reports, the official journal of the PHS, this was a straightforward, authoritative message to state-level grantees. Decision makers in Tennessee got the message. In 1945, that state authorized establishment of an industrial hygiene operation in its Department of Public Health and made the results of its studies and investigations unavailable for any compensation claims or lawsuits.³⁰

Not every state chose to fall in line. Wisconsin took federal funds to set up an industrial hygiene unit under its State Board of Health in 1937 but continued to make the fruits of state investigations of hazards available to compensation applicants. Harry Nelson of the Wisconsin Industrial Commission told his peers in the International Association of Industrial Accident Boards and Commissions that “suppression of any pertinent testimony is always dangerous.”³¹

For the most part, New York held its ground. But even there, powerful interests fearful of silicosis liability made inroads. In 1936, shortly after the state broadened eligibility for compensation for occupational disease, lawmakers took up a proposal to study dust diseases but bar the admission of any information obtained into any compensation proceeding. The possibility infuriated Frances Perkins. When this measure came under serious consideration, she declared, “There can be no legitimate excuse for a provision that forbids the Industrial Commissioner, who is the administrator of the Workmen's Compensation Act, to utilize any information that will assure the fair and equitable disposition of a pending compensation claim.” Over these objections by the former commissioner, this bill became law in mid-1936. Otherwise, however, the nation's leading industrial state remained the citadel of the proworker approach. The Department of Labor's Division of Industrial Hygiene continued to assist compensation administrators in nonpneumoconiosis cases and to aid the federal DLS in training state inspectors in occupational disease issues. The division circumvented the restrictions on use of specific evidence of silicosis by launching an educational campaign on dust disease. The agency also continued to attack other hazards by producing numerous publications and engaging in other forms of outreach aimed at workers and their unions. To reach one sizable cohort of recent immigrants, the division placed fifteen articles in Italian-language newspapers in 1937. The following year, in a bulletin intended to reach not only labor but also management in lead-producing and lead-using establishments, it advised that “each and every applicant for employment should be informed of the special health hazards presented by exposure to lead, [and] the preventive measures available for his protection.” At the same time, the division investigated a benzene formulation that had caused scores of cases of poisoning among printers in New York City. Rather than submit a secret report to management at the completion of the study, the division's director, Leonard Greenburg, explained the situation at a union meeting. Greenburg also conferred with employers, their insurance carriers, and the manufacturer of the toxic ink. This intervention forced the substitution of an innocuous product for the deleterious one. New York remained a place where state labor officials broadly construed their mission to spread warning information.³²

Just as the PHS extolled the virtues of the Connecticut system, the DLS, run by migrants from Albany, promoted the New York model. Indeed, this worker-friendly program received the enthusiastic endorsement of that federal agency, which historians David Rosner and Gerald Markowitz aptly characterized as openly partisan. The DLS saw itself serving labor in the same manner that the officials of the Department of Commerce served commercial interests or, as we will see in chapter 3, the Department of Agriculture served farm owners. In 1939, the division published a detailed description of the system operating in New York State. Jean Flexner's pamphlet, The Work of an Industrial Division in a State Department of Labor, defended this orientation in the face of the dramatic rise of the health agency–based plans. Flexner observed that the NYDoL had its own medical staff whose duties included not only connecting reported illnesses to their causes by visiting workplaces but also sharing discoveries with workers, their doctors, and their unions.³³

Beyond its promotion of a particular strategy at the state level, the DLS on its own account promoted greater transparency regarding occupational disease. Consistent with its interest in treating workers not merely as wards of the state but as active participants in maintaining their own well-being, Zimmer's office offered another sharp contrast with its bureaucratic rivals. Beginning in 1935, the DLS put out a number of short pamphlets on important hazards that at least pointed toward a right-to-know perspective. To be sure, the first few pamphlets in the series did not supplement their main message about the necessity of engineering controls with any mention of the advisability of warning workers or involving them in the disease prevention process. Beginning with the publications appearing in 1937, however, the division struck a more activist note. Language encouraging employers to warn their employees about hazards like methyl alcohol and carbon tetrachloride and encouraging endangered workers to share their observations with their peers and to engage in collective self-protection became standard. The National Silicosis Conference of 1936–1937, sponsored by the DLS, brought forth formal recommendations that management take responsibility for instructing employees about silica hazards and how to avoid them. These recommendations harnessed not only the growing authority of the national government but also the endorsements of committees composed of prominent public and private experts, which conferred a measure of additional legitimacy on the concept of greater workplace transparency. In this fluid and turbulent political context, even modest attempts to activate workers helped to stimulate a sense of entitlement that pointed the way toward the subsequent dawning of a deeper consciousness of rights.³⁴

State-level labor administrators and their allies struggled to limit, if not reverse, the dominance attained by their rivals in the health bureaucracies. Besides their relative lack of resources compared to the federally endowed health organizations, the labor departments resented the way that they were kept in the dark about investigations and were otherwise the victims of a lack of cooperation. As the 1930s came to a close, supporters of the labor-friendly approach waged two battles in the legislative realm. The first of these seized on the Roosevelt administration's efforts to forge a comprehensive national health program, which had been revived at the National Health Conference of 1938. In addition to the primary interest in a government health insurance plan, deliberations at that event did reach the issue of the allocation of funds for occupational health. The conference's Technical Committee recommended that all states develop industrial hygiene programs under the control of health departments, in part to meet the need to expand education on occupational disease.³⁵

When reform proponents advanced their proposal the following year, the stage was set for another jurisdictional battle on which one object of contention was the distribution of information to workers. Because the National Health Bill only called for vague forms of cooperation between labor and health officials, skeptics testified in Senate hearings in support of an amendment that would secure funding for state-level labor departments. Matthew Woll of the American Federation of Labor worried about the withholding of facts about hazards needed by compensation applicants and defended the New York system of integrating investigative and compensation functions. Leonard Greenburg spelled out the mechanics of New York's procedure in contested cases: “When a man makes a claim for compensation for an occupational disease we get a record of his claim and our medical expert goes to the factory where he works, he sees the process at which the man was engaged, he takes samples of the material to which the man was exposed, and he brings it back to the chemical laboratory for analysis, and he writes a report based on the medical findings, and the chemist writes a report on the material analyzed, and they go into the compensation folder as evidence.” Mary McGorkey, chair of the Health Committee of the New York section of the Congress of Industrial Organizations, applauded the work of Greenburg's team and maintained that the next challenge for the labor movement was educating its membership. Defenders of the health department model held that labor department programs suffered from crippling liabilities. C. P. McCord of the Michigan Department of Health alluded to their “disagreeable” associations with issues like strikes. (McCord did not share with the senators the fact that two years earlier Michigan had passed a law that hid from public view the findings of state investigations of occupational disease, except where the health commissioner deemed it advisable to divulge information to employers.) Morris Fishbein of the American Medical Association dismissed the successful experience of New York State as an exceptional one that could not be replicated elsewhere. Thomas Parran, New York's health commissioner, not only trivialized his own state's industrial-hygiene program as a fluke of history but pointed admiringly to the system invented in neighboring Connecticut. Invoking his twenty-two years in the NYDoL, Verne Zimmer responded to this provocation by criticizing the inability of Connecticut's public experts to convey information helpful to victims of occupational disease seeking benefits. Zimmer contended that the educational duties undertaken by government authorities should extend to encouraging the “part to be played by workers in preventing occupational disease.” Defenders of the now-embattled New York alternative won no congressional concessions from this altercation.³⁶

In the second assault on public health monopoly control over funds, James Murray, a liberal Democratic senator from Montana, sponsored a bill—drafted by the DLS and one for which it attempted to mobilize union support—that would allow state labor bureaus to obtain financing from Washington. On the eve of hearings on this proposal, Frances Perkins did her best to set the terms of debate. In her view, “The major need at present is not one of additional medical research but a wider use of existing knowledge about these health hazards. This can be promoted by extended distribution of non-technical information to workers and management,” as well as by regulations that imposed well-known engineering controls. She criticized the Connecticut policy of withholding assistance from compensation claimants and denounced the actions of health officials elsewhere. Perkins was especially appalled that, in Illinois and Pennsylvania, health department physicians had served as expert witnesses for employers’ insurance carriers to oppose occupational disease claims. For its part, the PHS prepared for the hearings by lining up witnesses from Connecticut.³⁷

The Senate hearings held in May 1940 generally ranged over familiar ground. Supporters of Murray's proposition contended that wider availability of information gathered by the state for workers seeking much-needed public benefits was only fair. Opponents attacked the bill as a wasteful duplication of effort while insisting that state health departments cooperated with their labor department colleagues and offered appropriate technical assistance to the compensation system. Albert Gray, still the director of Connecticut's Bureau of Occupational Disease, blandly assured senators that “in most States cooperation between industrial hygiene units and compensation bodies is excellent.” The bill, which lacked President Roosevelt's endorsement, died quietly. Although skirmishing on this issue continued for a decade thereafter, this moment marked the end of any viable chance of limiting the control held by health authorities at the state and federal levels.³⁸

Having effectively consolidated its authority over occupational disease as a societal issue, the PHS and its allies pressed forward in propounding an enlarged conception of their domain. Confined by industrial hygiene and long oriented toward nonoccupational disorders, in the 1940s the PHS increasingly described its mission in terms of the more capacious concept of industrial health. The emergency conditions of World War II were propitious for focusing on ailments like influenza or the common cold. Maladies of that sort caused considerable absenteeism, impeding productivity in vital defense industries. Thus, state health departments took up nonoccupational problems of adult health more frequently. In 1940, Ohio converted its Bureau of Occupational Disease into an Adult Hygiene Division. Broader horizons meant additional attention to noninfectious chronic conditions like cancer and cardiovascular disorders while continuing to deal with familiar infections like tuberculosis and sexually transmitted diseases. With inevitable limits on staffing and other resources, this expansionist move left occupational disease further down the lengthened agenda of the public health bureaucracy and of the health-care providers under its influence. As Carey McCord, then an adviser to Chrysler Corporation, told the Institutes of Wartime Industrial Health in 1942, “All physicians have been brought closer to industrial health through the realization that work injuries and occupational diseases make up only a minor portion of the health conservation problems of industry.” Educating workers about occupational health hazards, especially those with long latency periods, became an even lower priority. The PHS promoted joint labor-management committees, which proliferated during the war, as a key instrument for delivering health messages to workers. Under the preferred division of responsibilities, management committee members would teach employees about the occupational hazards they faced, and labor representatives would cover risks emanating from outside the working environment. In 1944, PHS health educator Elna Perkins advised that “labor unions will be expected to assume their share of the responsibility for education of their members on health matters.” To Elna Perkins, this meant that “unions should promote health education that will help individual members to improve their own hygienic habits of living and to take advantage of health services available.” In a 1946 editorial in its monthly newsletter, the PHS Division of Industrial Hygiene promoted “the modern concept of industrial hygiene.” Using data flawed by under-reporting and under-recognition, the federal health agency maintained that “for every day lost to industrial diseases and accidents, fifteen are lost as a result of ordinary adult illnesses.” The editorial went on to encourage company doctors to “give workers advice on nonoccupational illnesses.” As unions in the postwar years began to press more forcefully for employer-funded hospital and medical benefits, an emphasis on educating employees on health-promoting behavior had a clear money-saving value for management. Assigning company physicians an educational role also served to placate the medical establishment's unease about competition from that source in the lucrative delivery of clinical services. The new industrial health paradigm renovated and reinforced the old victim-blaming strategy.³⁹

The bureaucratic battles over occupational disease that played out over almost four decades had come to a decisive resolution by midcentury. Programs located in state and federal labor agencies had been subordinated or eliminated by their adversaries in health officialdom, led by the PHS. A postwar reactionary wave inflicted severe budget cuts on the DLS and the dismantling of its educational program. It is impossible to gauge with any precision the number of opportunities for enlightening workers about their health hazards that were lost as a result of the triumph of secrecy over transparency. But the crucial nexus weakened, if not severed, was that between government authorities and a resurgent labor movement. With union membership in the United States quintupling between the early 1930s and the late 1940s, there was definitely potential leverage for making gains against unhealthful working conditions. But a wider and deeper awareness among the union rank and file of its peril was an essential precondition for progress. Health officers preoccupied with research and with maintaining cordial relations with those who owned and managed their research sites could not deliver the necessary warnings. As Rosner and Markowitz have demonstrated, the DLS worked in close alignment with organized labor and supported state-level agencies with the same orientation.⁴⁰

Some sense of the opportunities lost comes from the exceptional experience of federal intervention in the rayon industry. In 1937, the Textile Workers Organizing Committee, an affiliate of the insurgent Committee for Industrial Organization (which a year later renamed itself the Congress of Industrial Organizations), sought the assistance of the Division of Labor Standards on the carbon disulphide (or carbon bisulphide, but today known more commonly as carbon disulfide) and hydrogen sulphide hazards sickening workers in the burgeoning viscose rayon industry. The DLS enlisted the services of Alice Hamilton, in what would be her final major assignment as a federal consultant. Hamilton was all too willing to address a threat that management had obscured under what she termed “a mantle of almost complete secrecy.” After helping the Pennsylvania Department of Labor and Industry design a survey assessing the problem among the state's approximately ten thousand rayon workers, Hamilton led a national study involving thirteen plants in ten states. Her 1940 report on this project brought to light pervasive acute and chronic intoxication from carbon disulphide as well as widespread adverse effects of hydrogen sulphide exposure. She made clear that she had written this document to be understandable to union representatives and other laypeople. Rather than await the results of this investigation, the DLS offered a new entry in its health and safety pamphlet series in 1937. The DLS pamphlet urged that a worker suspecting that he or she was being poisoned by this substance “talk the matter over with his fellow workers and with the management,” as well as to notify the state labor department about the situation. The guidance to employers whose worksites harbored this toxic chemical contained this suggestion: “Inform all employees about the possible danger of carbon bisulphide poisoning, and the measures for their protection.” In this case as in others at this juncture, federal agents promoted activism based on transparency. The DLS's Clara Beyer announced in 1937 that, in response to “tremendous interest” from workers, her agency had distributed 150,000 copies of each of its hazard pamphlets. Union branches were requesting them in batches of five hundred. This information dissemination strategy departed radically from that employed by their counterparts in health agencies, which concentrated on reaching employers and physicians. If it had become the norm, the Labor Department alternative methods might well have substantially benefited unionizing workers, particularly in the manufacturing sector. Instead, the dominant trickle-down approach fostered by health officials depended on employers accepting responsibility to create knowledge that might expose them to lawsuits or compensation demands.⁴¹