1A VERY GENERAL IGNORANCE

It is universally recognized as the moral duty of every civilized state to secure and publish information of vital importance to all citizens to promote safety and health.

—Illinois Legislature, 1907

The well-meaning lawmakers in Illinois were wrong with regard to one important type of health information. There was no universal recognition of a moral duty to disseminate workplace hazard information as of 1907. There was no public policy reflecting such a commitment. The concerns animating this aspirational claim in Illinois and elsewhere in America, however, were beginning to bear fruit at that moment. Inquiries and observations by numerous public and private actors in the early twentieth century elevated the principle of transparency regarding occupational health hazards. These interventions marked an advance toward the distant goal of fully informing the public and especially at-risk workers about these dangers. The Progressive Era witnessed the first significant, if halting, steps toward the establishment of a right of American workers to know about the health risks they encountered on the job.

By the turn of the twentieth century, the industrial development of the United States had brought with it both the exacerbation of old hazards of occupational and work-related disease and the generation of new hazards. Many types of deleterious dusts, fumes, vapors, gases, and liquids often contaminated the environment of factories, mills, and other worksites. These chemical threats were supplemented by biological and physical agents of disease. A sizable share of the nation's diverse workforce exposed to these myriad risks existed in an especially precarious state of structural vulnerability to illness, disability, and death. Mass immigration from southern and eastern Europe and other nonindustrial areas meant that language barriers, nativist and racist prejudices, and discriminatory job assignments, as well as a lack of industrial work experience, intensified the vulnerability of millions of foreign-born laborers. Many native-born workers, especially those of color, also could not avoid suffering. Revelations of the mounting toll in morbidity and mortality from lead and arsenic poisoning and other work-induced afflictions placed the widespread nonrecognition of workplace hazards on the reform agenda of some reformers in the first quarter of the twentieth century. Legislative, regulatory, and other actions by states brought a modicum of enlightenment to a fraction of the most endangered workers and produced a body of policy-relevant knowledge for future initiatives.¹

Exploratory work by government officials began in earnest in the first decade of the century. In 1907, Massachusetts set up a system of medical inspection that encompassed working conditions. Inspectors reported numerous situations involving both exposure to toxic chemicals and the health consequences thereof. Elliott Washburn's 1908 visit to a factory that produced patent leather yielded the observation that employees were almost constantly inhaling intoxicating naphtha fumes. According to Washburn, “‘Naphtha drunks’ were said to be not uncommon among the workers. The minors at work were all Italians, young and rugged, recently landed.” Inspectors found lead hazards in several industries. At Massachusetts General Hospital, they located eighteen cases of lead poisoning among men engaged in making rubber. In 1909, the State Board of Health official William Hanson reported, “Inasmuch as a great proportion of the rubber workers are foreigners—Poles, Italians, etc.—the patients themselves may not understand fully the nature of the trouble for which they are treated.” To address the “general ignorance among employers and employees,” he recommended the placement of warning notices in conspicuous places in the rubber factories. Hanson also expressed dismay at the plight of metal polishers who inhaled toxic dusts, many of whom “do not realize the danger to which they are exposed.” Just as it had pioneered factory safety inspections in the 1870s, Massachusetts broke new ground by entering the area of monitoring health risks.²

Subsequent efforts in three other states proved to be more extensive and intensive. Investigations in Illinois, New York, and Ohio all gathered a wealth of data on both emerging and well-entrenched hazards. The first of these got underway in Illinois in 1909. The key figure in this inquiry was Alice Hamilton, not only the mother of American occupational medicine but also arguably the grandmother of the right-to-know movement. A veteran of Chicago's Hull House settlement, Hamilton later became the first woman to hold a faculty position at Harvard. She brought both a Progressive reformist sensibility, with its faith in bureaucratic structures and processes, and a commitment to rigorous fieldwork to her role as the chief investigator for the Illinois Commission on Occupational Diseases. Focusing her energies on the preeminent hazard of lead poisoning, she visited 304 workplaces, several health-care institutions, and countless workers’ homes. She found that immigrant men comprised the majority of the thousands of workers inhaling and ingesting lead on the job across about twenty industries and trades. In her autobiography, Exploring the Dangerous Trades, Hamilton reflected on the makeup of the contingent that applied enamel to bathtubs and other sanitary ware: “They were almost always foreigners, Bulgarians, Serbs, Poles, Italians, Hungarians, who had come to this country in the search for a better life.” She learned that in many instances management gave employees neither warnings about the threat they faced nor guidance about avoiding that threat. Based on conversations with managers, she attributed much of this failing to the managers’ own lack of knowledge: “We found … a very general ignorance of the hygiene of the lead trades on the part of the employers. In Europe and England employers have been carefully trained in industrial hygiene, but here they have been taught nothing.” The labor force in smelters, paint shops, storage battery plants, and white-lead factories followed the pattern of recent arrivals from agrarian societies. Hamilton told a joint session of the American Economic Association and the American Association for Labor Legislation in December 1910 that “only the most ignorant and helpless foreigners seek employment in the white lead or lead smelting works.” For the notorious white-lead production facilities, she urged the posting of “simple instructions in different languages,” a suggestion she reiterated for other contaminated working environments. She characterized as merely the tip of the iceberg the total of 578 cases of lead-induced disease discovered by various methods. Her own examinations of 148 Slavic enamelers determined that almost two-thirds had a definite or probable diagnosis of lead poisoning. Hamilton noted that “the majority of physicians keep no record of their cases; some do not even attempt to keep the names if these are foreign and hard to catch.” This formative experience much strengthened her dedication to advocacy for the most vulnerable migrant laborers. The experience also forged an abiding commitment to the worker's right to know about health risks. Based on her interactions with lead-exposed cut-glass workers, she maintained, “It is essential that the workmen understand what it is they are using, and for this purpose simple statements explaining the facts should be displayed.”³

Hamilton's coworkers pursued hazards other than lead that menaced the workforce in Illinois. The physician Emery Hayhurst's visits to eighty-nine brass foundries involved inspections of conditions and roughly two hundred interviews with workers and managers. Those inspections produced evidence of widespread intoxication with the disorder commonly known as the brass chills or brass shakes, a problem caused by inhalation of metal fumes. Hayhurst's tour of zinc smelters similarly brought to light the prevalence of the neuromuscular ailment called the smelter shakes, which resulted from uncontrolled air contamination. The workforce in both industries was largely composed of international migrants. Hayhurst concluded that very few of the Polish men who dominated the smelter crews spoke or understood English. This obviously posed an obstacle to ascertaining the presence and nature of occupational disease. The communication barrier also posed an obstacle to determining the state of the workers’ knowledge of the risks they faced. Unlike his colleague Hamilton, who attempted to surmount these difficulties, Hayhurst apparently failed to delve into the extent to which English-speaking managers understood hazards and warned their subordinates of them. The same disregard for this question of knowledge and ignorance characterized the investigation of painters’ gastrointestinal and respiratory illnesses resulting from turpentine exposure, a study in which Hayhurst also participated. In contrast, when Walter Haines, Matthew Karasek, and George Apfelbach inspected five steel mills around Chicago, they called attention to the efforts of management, especially at Illinois Steel Company (a US Steel Corporation subsidiary) to educate employees about threats by use of oral and printed messages. At the massive South Works of Illinois Steel, the warning signs around furnaces and other areas where carbon monoxide lurked appeared in English, Hungarian, Russian, Polish, and Czech. The report by Karasek and his wife Stella Karasek on the injurious effects of the hazards of photoengraving called attention to dermatological conditions caused by chromic acid and instances of acute cyanide poisoning. The Karasek team criticized the fact that in the forty photo studios evaluated, “there were no posters, instructions or warnings to the employees regarding poisonous and dangerous chemicals; neither were labels present on any of the bottles containing potassium cyanide or other chemicals used.”⁴

The report sent to the governor by the Illinois Commission on Occupational Diseases in January 1911 embraced a right-to-know perspective to a considerable extent. To be sure, the commission declared a preference for controlling health hazards more systematically through engineering controls such as ventilation and enclosure. Nonetheless, it asserted the value of greater dissemination of information, insisting that “much can be accomplished by the wide publication and posting in shops of the dangers attending particular processes of manufacture and the best means of preventing injuries.” The commission's secretary, University of Chicago professor Charles Henderson, made clear that union leaders had requested “brief, plain, practical directions for the working men in different trades so that they may be able to avoid disease.” Thus, the group put forth a few recommendations for the display of warning posters and the issuance of instructions on recognizing and avoiding health risks. The commission couched its recommendation for further investigation of the occupational disease problem in dark terms. “A policy of concealment and of obstinacy in willful ignorance,” the commissioners warned insinuatingly, “is a folly unworthy of our noble commonwealth.” They maintained that the public interest required that “evil and harmful conditions shall be brought to light, that workmen may be taught their dangers.”⁵

The Illinois commission's report went into some detail in specifying the ameliorative measures sought. Its draft occupational disease law required the posting of hazard warning notices in conspicuous places and that notices contain information on methods of preventing disease. The provision on notices also mandated that “in addition to English they shall be printed in such other language or languages as may be necessary to make them intelligible to the employees.” This proposal for multilanguage messages picked up on the suggestions made by Hamilton and her fellow investigators as well as the established practice of US Steel, a prominent and prestigious firm. Such a commitment was not unprecedented in Illinois public policy. In 1909, the state had enacted a law requiring that “poisonous and noxious fumes or gases and dust injurious to health, arising from any process, shall be removed as far as practicable.” Although “practicable” was a term vague enough to undercut the law's impact, of relevance here is the requirement that notices spelling out the basic provisions of the act in languages other than English be posted in workplaces. The commissioners’ report suggested warning notices, albeit only in English, for both employers and employees that addressed various lead hazards. The reformers indicated that these could serve as templates for delivering guidance on other hazards. Illinois legislators immediately passed a bill that charged employers with the responsibility of displaying multilanguage signs to apprise their labor force of the dangers of lead and other toxic substances. But with a sizable share of immigrant workers illiterate in their native languages, this measure could have only limited effectiveness. Taken together, however, the actions of the Illinois commission constituted significant beginning steps toward the democratizing of access to occupational health hazard information.⁶

A catastrophic fire in the Triangle Shirtwaist Factory in New York City on March 25, 1911, prompted a systematic state evaluation of working conditions across the state. This evaluation soon extended far beyond the issue of fire safety. As in Illinois, the New York State Factory Investigating Commission found itself dealing largely with the inordinate risks of industrialization borne by those newly arrived from preindustrial homelands. Without the funds needed to conduct medical screening of large numbers of workers and former workers, the staff of the commission focused on the types of disease that exhibited unmistakable, distinctive symptoms and disorders that could produce valid reports from either the victims themselves or other nonmedical observers. This orientation placed lead and the other heavy metals at the center of attention.⁷

New York State harbored an abundance of lead hazards. An investigative crew led by the economics professor Edward Pratt inspected several lead-filled establishments in New York City where immigrants from southern and eastern Europe were joined by a contingent of men of African descent from Barbados. Some who understood the threat used bandanas or rags to try to intercept high concentrations of dust and fumes, with limited success. Pratt's group determined that workers took these protective actions even though their managers seldom gave them warnings in any form. These investigators learned that only seventeen of ninety poisoning victims had received any hazard instruction. Pratt concluded that “one of the things which must be done … in stamping out lead poisoning is to instruct the rank and file of workers in lead as to the danger of the poison in which they are working and the methods of prevention.” At the commission's hearings in late 1911, the physician for the National Lead Company plant in Brooklyn contended that he had discovered few lead poisoning cases but conceded that he could not communicate with most of his patients. At one of the world's largest glass works, the investigators Charles Graham-Rogers and John Vogt observed in the manufacture of leaded glass that “none of the workers exposed to the danger are aware of it, and as they understand very little English, it is hard to make them understand.” Graham-Rogers and Vogt found in their inspection tour that “in many instances the proprietors themselves are unaware of the presence of lead in the material used, or the danger therefrom.” Management at a storage-battery production facility in Niagara Falls denied that there was intoxication among its largely foreign-born workforce of about three hundred. Yet the admission by the company's chief engineer W. L. Bliss that this “class of work isn’t congenial to American taste” implied the existence of a possible problem.⁸

The Factory Investigating Commission's field staff, along with its witnesses at public hearings, illuminated the unhealthful conditions of exposure to a number of hazards besides lead and the general failure to alert employees to those hazards. Chemical manufacturing unleashed a host of perils, new and old, upon a workforce three-quarters of which had been born in either Italy or Poland. A review of working conditions and employment relations in 359 chemical factories led the commission to a dismal assessment: “In no other industry is a knowledge of the poisonous substances which are handled so necessary to the worker; but in no other industry is the ignorance of the worker as to the character of … substances with which he works so complete.” George Price, the commission's director of investigation, excoriated those responsible for the plight of “the large number of unskilled, densely ignorant foreign laborers who are employed in extremely dangerous processes. Taking advantage of this ignorance of the worker and subjecting him to conditions fraught with fearful danger to his life may be characterized as the peculiar reproach of the chemical trade.” Price maintained that these international migrants were “not regarded as ‘white’” by their employers. His tour of dozens of production facilities left him convinced that warnings delivered in the workers’ native languages were a rarity: “There is very little attempt made on the part of managers to instruct the foreign laborer in the dangers of the materials with which he works or the inevitable peril to his life consequent on certain processes. Very few printed notices or precautions are posted in the native languages of the workers.” He believed any warnings came from an ulterior motive: “Whatever notices or cards are found in the chemical establishments do not seem to serve as a means of instruction, but rather as an extenuation for the manufacturer, placing the onus upon the employee in case of a suit for damages.” Henry Carnegie testified that his job shoveling bleach into drums at Hooker Electro-Chemical Company subjected him to such intense doses of the respiratory irritant chlorine that he could only labor for brief intervals; spilled materials ate his shoes at the rate of a pair every week or two. Neither Carnegie nor two coworkers who also testified at hearings on October 4, 1912, received any hazard avoidance instructions from Hooker management. Vogt visited a site where the ancient poison arsenic was used by a staff of Polish, Italian, and Russian Jewish migrants to manufacture the colorant Paris green. The shop had neither a ventilation system nor any warning signs. The language barrier thwarted the attempt by Vogt and Graham-Rogers to ascertain whether exposure to the arsenic impurities in zinc was sickening the foreign-born workers in four galvanizing plants they visited. However, the investigators came away with the definite conclusion that workers were unaware of the risks involved. Vogt testified before the commission that a “policy of indifference and concealment” prevailed in the nascent chemical industry. The manager who oversaw production of muriatic acid at Niagara Alkali Company testified that his subordinates wrapped flannel around their mouths even though acid vapors posed no hazard to them. Commission investigators who toured his facility, however, found the air quality “unbearable for two minutes” and considered exposed workers “poorly protected.” The physician Antonio Stella's work among immigrants gave him insight into one of the ways that problems remained somewhat concealed across a range of dusty occupations. Stella advised the commission that dust-generating industrial tasks gave his Italian, Greek, Slavic, and Spanish patients silicosis or silico-tuberculosis. He contended that remigration of the disabled to their homelands led to underestimation of the prevalence of these disorders.⁹

The lessons from the wealth of information gathered by the New York commission prompted a number of reform recommendations. Edward Pratt expressed doubt that more than 10 percent of lead-exposed workers could read warning signs, all of which were printed only in English. Pratt advocated for the display of multilanguage warning posters and that “some person acquainted with the languages of the various nationalities … personally interview each man and instruct him” in safe practices. Besides these corrective actions to be undertaken by employers, Pratt urged that the state Department of Labor launch “a campaign of education among the workers in industries in which lead in any form is used, by means of circulars printed in different languages and by means of talks and lectures before groups of workers in the factories and trade union meetings.” His colleagues Price, Vogt, and Graham-Rogers concurred in these recommendations. The commission itself broadened this suggestion to encompass educational publications on other hazards as well. Perhaps more important, the commission proposed legislation for structural reforms to strengthen the capacity of the state labor department to expand the right to know.¹⁰

The New York legislature quickly put this progressive plan into law. The legislation of March 28, 1913, created a new Division of Industrial Hygiene with authority to investigate and regulate occupational health problems. The granting of direct general regulatory authority to state labor administrators was an important departure that facilitated the development of public policy and practice. Business owners had to post state regulations or digests thereof in hazardous locations, in whatever languages the authorities deemed appropriate. The reorganized Department of Labor was obligated to hire an inspector capable of speaking and writing in at least five languages other than English.¹¹

In implementing this reform, the New York labor department embraced a firm commitment to disseminate hazard information. State Labor Commissioner James Lynch observed that the reform law meant that his department “should become a larger educational agent.” Lynch welcomed the opportunity. To be sure, the fledgling efforts of the understaffed Division of Industrial Hygiene to deal with a few hazards brought no immediate transformative enlightenment in the endangered ranks. Nonetheless, Progressives in New York had managed to establish an important beachhead in the early stage of the struggle for transparency.¹²

The final major state study of the decade took place in Ohio in 1913 and 1914. The State Board of Health carried out this project, under the leadership of Emery Hayhurst, a veteran of the Illinois investigation. Field investigators, almost all of whom were physicians, evaluated conditions in more than one thousand establishments, mainly in the state's sprawling manufacturing sector. The Board of Health reporting guidelines unfortunately conflated workers’ mental capacity and their possession of knowledge in a way that put nativistic condescension out in the open. Staff were told to characterize “the type of workers, whether intelligent, responsible, and capable of understanding instructions or whether an ignorant and usually non-English speaking class.” Despite this prejudice and other limiting factors, the survey did manage to throw a good deal of light on right-to-know matters related to hazard exposures and their health effects.¹³

The Ohio inquiry consistently pursued the question of whether management conveyed hazard information to at-risk employees. Of 43 iron foundries, where silicosis posed a common threat, only 8 delivered any disease-prevention instructions. No health warnings were given in 92 of 106 brass foundries, where lead commonly contaminated the working environment. Intermittent commentary on workforce composition adhered to the prescribed terminology, noting the presence of “more or less ignorant foreigners, non-English speaking” in many metal-grinding establishments, where managers in only 10 of 64 places gave any warnings. The Board of Health assessed risks at 25 junk-processing sites, 17 of which relied upon “ignorant foreigners” to endure exposure to lead and other toxic substances. “There were no instructions or health placards in any of the establishments,” the state agents reported, “including those which brought the workers in contact with poisonous metals and fumes.” The Hayhurst team did not explore the degree to which this failure to inform resulted from managerial lack of understanding of the hazard. They did not explain why most firms failed to inform their employees about serious, well-known risks. In the same vein, their review of 1,060 workplaces contained not a word of criticism of the substance of the health messages posted on any warning signs, even though investigators were charged with reporting “wrongful instructions.” This oversight contrasted starkly with the numerous critical comments about employees’ personal hygiene and other behavior.¹⁴

The Ohio assessors gained relatively little insight into the incidence of occupational diseases. Interviews with uninformed workers yielded evidence of symptoms but limited understanding of the causation of their illnesses. Here again, the language barrier operated to curtail the gathering of data. The State Board of Health did not take this opportunity to use its medical expertise to combat ignorance. The fieldworkers were instead forbidden to enlighten those being observed about the causes and nature of their problems. Hayhurst stated plainly that “investigators were carefully instructed … not to pass opinions upon working conditions to employees, nor to express to any employee who was questioned or examined any opinions concerning his or her state of health as determined by the physician-investigator.” At least in part, this restriction may have stemmed from the fact that investigators were not authorized to conduct a thorough physical examination but instead had to confine themselves to cursory observations of the workers’ appearance, usually an insufficient basis for an authoritative diagnosis. Superficial comments that a group of employees looked pale or unhealthy recurred in the survey report.¹⁵

Hayhurst's mandate from the Ohio General Assembly extended to making remedial recommendations. His report declined to advocate any strong legislative measures, such as banning certain uses of lead or requiring ventilation systems or other engineering controls. “As most of the problems concerned have to do with education and the creation through appeal and psychological means of a receptive and subsequently active state of mind of the masses concerned,” he argued, “it does not appear that much legislation is necessary.” In a sense, a vague commitment to education (for which Progressives had great, sometimes uncritical, enthusiasm) and increased receptivity became a means of deflecting interest away from more substantial reforms. The state's lawmakers had already provided an inviting opening for new right-to-know protections. In 1913, Ohio addressed the lead hazard by requiring that employers post warning signs in all the languages needed to reach their employees effectively and that they have interpreters hold monthly informational meetings on the dangers of lead. Extension of this precedent to arsenic, mercury, benzene, and other recognized threats would have been a natural move for Hayhurst at this juncture. Instead of support for using the force of law to help enlighten the diverse workforce in that way, this state health official placed his hopes for dissemination of information on a voluntaristic approach. The only recommendation relevant to mandatory production of knowledge of occupational disease was a proposal for reporting cases of occupational disease to the Board of Health. This idea drew on the long-established public health policy of requiring clinicians to make case reports of certain infectious diseases. By 1901, all states forced doctors to notify health authorities of cases of specified communicable disorders seen among their patients.¹⁶

Progressives had great confidence in the unique capability of scientific experts, in and out of government, to solve the social problems of industrializing America. Reacting to the recent report of the Illinois commission, the University of Iowa economics professor Paul Peirce envisioned organized scientism bringing societal enlightenment: “It is to agencies such as these—commissions, clinics, medical inspectors, and compulsory examinations and reports—and to the wide-spread publicity of their findings that we must look for guidance toward the prevention of unnecessary industrial disease.” The American Medical Association hastened to agree with Peirce's prescription. Reformers considered the ignorance of occupational health hazards exhibited by the medical profession and by state agents to be especially troubling. Hayhurst's support for mandatory reporting of cases aimed to tackle those deficiencies by utilizing a standard public health procedure to orient the medical profession to the existence of an underrecognized issue. By the time of the issuance of the Ohio survey report, a national campaign led by the American Association for Labor Legislation (AALL) was well under way for obligatory reporting by physicians of their cases of major occupational disorders. An affiliate of the International Association for Labor Legislation, the AALL saw as an integral part of its mission the importation of European reforms. In this case, Great Britain's adoption in 1895 of a legal requirement for physicians to report lead, phosphorus, and arsenic poisoning and anthrax served as the exemplar of progress. Six years later, the British parliament added mercury poisoning to the list. Discussion at the association's December 1910 annual meeting noted the unfortunate extent of medical ignorance that the Illinois commission had recently discovered and the cost of that ignorance. The group decided to promote a model bill as one of its top legislative priorities. The AALL proposition sought to make reportable the five conditions enumerated in Britain, as well as compressed air illness.¹⁷

The following year, six states—Connecticut, New York, California, Michigan, Illinois, and Wisconsin—adopted this measure, or slight variations thereof. None of these laws limited access to the information thus provided, opening the possibility that knowledge might trickle down to workers and their unions. In recounting the recent successes, John Andrews, the association's secretary, indicated that one of the aims of the legislation was “to secure for public use a regular supply of information from those who should be best informed upon the subject.” Andrews expressed hope that the governmental agents would supplement this data by following up with investigations of the disorders revealed. He also appealed to the medical profession to use its unique potential to create broader societal understanding. His article in the April 15, 1911, issue of the Journal of the American Medical Association shrewdly relied on one of the profession's own authorities: “‘Medical men alone,’ said Dr. William Hanson of the Massachusetts Board of Health, ‘are in a position to make the best use of facts obtained concerning the sanitary conditions of premises where men and women work; … and to collect and make proper use of all facts and data, including morbidity and mortality statistics, pertaining to occupational hygiene.’” Two more states—New Jersey (where the state federation of labor instigated reform) and Maryland—passed disease-reporting legislation in 1912.¹⁸

Beyond the behavior of individual clinicians in private practice, Progressives looked to systematic action by organizational players. Faith in modern organizations (generally government, academic, and corporate bureaucratic structures) as appropriate agents for producing and distributing scientific knowledge guided this endeavor. In 1912, W. Gilman Thompson, a professor of medicine at Cornell University Medical College who would soon publish a pioneering textbook in the field, urged not only further education of physicians in the recognition of occupational disease but also a more inclusive initiative targeting rank-and-file chemical workers. Thompson encouraged the New York Section of the American Chemical Society to have its member firms provide danger signs and printed directions for handling toxic chemicals and that they set up workers’ committees to help implement the educational program. At the same time, Andrews nudged the New York Department of Labor to publish and distribute “short industrial disease leaflets for workers” and assured his contact in the department that Thompson and his colleagues “would be very glad to prepare the leaflets.” Proceeding simultaneously on a separate track, the AALL's Committee on Industrial Diseases started preparing its own leaflets and other literature.¹⁹

Unions were one component of civil society that reformers understood could play a pivotal role in expanding workers’ knowledge. In 1909, C.-E. A. Winslow challenged organized labor to do more to inform its membership. In Winslow's view, the unions had “almost wholly failed to grasp the magnificent opportunity, which should be theirs, of bringing to the individual worker that knowledge of sanitary science which will enable him … to maintain a maximum of health and efficiency.” George Price played a singular role in helping the labor movement take on this issue. Price came to the New York State Factory Investigating Commission from the Joint Board of Sanitary Control, a novel institution set up to deal with health and safety issues in New York City's garment industry. The board was the outcome of demands of the International Ladies Garment Workers Union, a group whose membership base was largely comprised of immigrants from eastern and southern Europe, especially Jews and Italians. Under the auspices of the Joint Board of Sanitary Control, Price gave workplace lectures on industrial poisons and factory sanitation. In addition, Andrews sought out physicians to make presentations on industrial hygiene to labor organizations.²⁰

Progressives looked to company doctors as the contingent within the medical profession with the most potential for delivering hazard information to rank-and-file workers. Social reformers in the early twentieth century had inordinate faith in the ability of professional expertise to mediate class relations, and this faith extended to medical expertise in the industrial setting. The period witnessed considerable growth in the number of physicians and surgeons serving either directly on the staff of business firms or as contractors with them. Delivery of health services by employers constituted one component of a welfare capitalist system that expanded the employment relationship through the provision of a wide range of goods and services—housing, recreational facilities, pensions, profit sharing, and much else. The risk-filled transportation, extractive, and manufacturing sectors in particular added medical professionals to render curative, screening, and preventive services. Delivery of each of these types of service afforded opportunities to inform workers of their exposure to health threats and how they might avoid those threats.²¹

The challenges for the company doctors often began with their own ignorance. Without any specialized training in occupational medicine, these practitioners generally had much to learn about the nature and causes of the ailments presented by their patients. Harry Mock, medical director at Sears, Roebuck and Company, acknowledged the deficiencies of many supposed specialists, who frequently had no awareness of even prevalent and well-known work-induced diseases such as lead poisoning. “Ignorance such as this,” Mock complained in 1919, “is inexcusable…. Unfortunately, the reputations of many company physicians in the past have been of the lowest standard professionally.” His assessment of the standing of this group was shared by Alice Hamilton, who contended that “for a surgeon or physician to accept a position with a manufacturing company was to earn the contempt of his colleagues.” To help uplift his fellows to competence and respectability, Mock produced a major textbook. His Industrial Medicine and Surgery contributed both an overview of occupational diseases and basic guidance for conducting a practice in this embryonic specialty. The tome offered a short checklist on the dispensing of hazard warnings: “Have you carefully instructed the management and employees in all hazards represented by their work and the best means of prevention? Are new employees instructed in the same before going to work?” Alerting the newly hired obviously dealt most straightforwardly with the paramount aim of primary prevention of disease.²²

Their place in the managerial structure of the firm sometimes made it difficult for company doctors to share information. The main tasks of most doctor-managers were performing preemployment and periodic screening examinations and reviewing the cases of sick employees. Notifying those examined of a diagnosis of an occupational disease and suggesting ameliorative steps to limit or reverse the condition constituted the main teaching moment available. In these situations, a fundamental tension existed between divulging and concealing information, especially regarding employees who might use diagnostic reports as evidence in lawsuits or workers’ compensation claims. At an eastern lead smelter that Alice Hamilton toured as a federal consultant, she met a company doctor who viewed his immigrant patients with contempt and was “always ready to fend off a damage suit by certifying that the victim had heart disease.” She maintained that in general in her early experience “secrecy was … part of the doctor's loyalty to his employer. Of course, I found this to be a very great obstacle. It was not only secrecy toward the men, but toward the public and toward me.” Hamilton's interactions with company physicians in places that made the toxic explosive trinitrotoluene (TNT) left her dismayed. In contrast with the information sharing of physicians associated with Britain's Ministry of Munitions, US physicians were “for the most part ignorant and indifferent, or secretive at the behest of their employers, who thought that frankness might frighten the men away.” Josephine Bates of the National Civic Federation found that two medical contractors stopped getting patient referrals after they told victims of mercury poisoning the real cause of their maladies and advised them to avoid further exposure. Hamilton and Bates lent credence to the cynical view that the company doctor's real patient was the company. Hamilton's brand of Progressivism plainly did not embrace the naïve view that reformers could somehow ignore class interest.²³

Yet a fraction of these managerial agents overcame or overlooked their employer's interest in nondisclosure. Some practitioners operated in organizations that tolerated or even embraced a measure of transparency. The policy of Norton Company, an abrasives manufacturer with a state-of-the-art program, was to share diagnostic information with the dust-exposed employees regularly examined. Under its standard procedure, Norton physicians even advised workers whose health was somewhat compromised to leave their jobs. The American Telephone and Telegraph physician C. H. Watson endorsed sending examination findings to the employee's own doctor. The Life Extension Institute in New York City promoted its screening services to businesses as a modern efficiency measure and maintained that annual employee examinations were as necessary as “inspection of other machinery.” The institute reported outcomes not only to its corporate clients but also to the physician designated by the individual examined for major problems or directly to the examinee for minor problems.²⁴

Government officials promoted disclosure of medical evidence. The US Public Health Service (PHS) endorsed an open approach by company physicians. The PHS surgeon Joseph Schereschewsky announced in 1914 that major industrial enterprises were accepting a “duty to minimize the effects of ignorance and carelessness in the production of sickness.” Schereschewsky believed that proper medical management should extend to advising workers of their physical condition. His colleague C. D. Selby concurred. At the 1918 meeting of the National Safety Council, Selby counseled that “personal talks, especially with the findings of physical examinations, are well received by working people and tend more to impress them than lectures or health bulletins.” In a frank characterization based on his survey of 170 plants, Selby described industrial medicine as “a compromise between the ideals of medicine and the necessities of business.” The New York Department of Labor in 1916 publicized the British policy that gave lead-exposed workers access to the results of their mandatory annual medical examinations.²⁵

Any notification of diagnoses of occupational disease and concomitant hazard control messages usually came as a secondary outcome of employee medical examinations. A much larger concern with nonoccupational disorders animated most such practices. To be sure, a host of illnesses and disabilities that were entirely or at least partly unrelated to work did plague the American labor force in this period, and health information on these conditions was certainly warranted. Even physicians like George Price, who had great sympathy for the precarious plight of workers new to industrialism, pressed the need to encourage personal habits that helped to curb infectious disease. But warnings about hazards lurking in the workplace environment were sometimes drowned out by advice about personal cleanliness, irresponsible spitting, alcohol consumption, and poor eating habits. Thomas Darlington, a physician with the American Iron and Steel Institute, did his best to shift the focus in a 1918 presentation: “Personally I do not believe much in occupational diseases…. Phosphorus and lead have been spoken of on many occasions as the most important occupational diseases. In the prevention of such diseases the thing of most importance is the care of the man himself, his personal hygiene, his home, and his surroundings.” Darlington held that teaching workers to brush their teeth would help them prevent heart disease and advocated sending nurses into employees’ homes to provide instructions. He asserted that proper handwashing would virtually eliminate lead poisoning. Close attention to self-care amounted to a crusade for Darlington. As a prominent spokesperson for a major industry, he exerted considerable professional influence. The Conference Board of Physicians in Industrial Practice, organized by leading corporate medical men in 1914, promoted a similar agenda. The board published a series of brief, simple “Health Hints” on personal habits, such as proper methods of breathing. This series was not supplemented by one on the prevention of any occupational diseases, including those incurred while breathing toxic dusts, fumes, or gases on the job.²⁶

At the worksite, where services actually took place, many company doctors shared this perspective. C. E. Ford, chief surgeon at General Chemical Company, lectured on sexually transmitted diseases but apparently not on dangerous industrial chemicals. A survey of seventy industrial physicians conducted by a team led by Michael Davis as part of the Carnegie Corporation's Americanization Study found that only six of the practitioners concerned themselves with occupational disease among immigrant workers. In contrast, twenty-two dealt with housing matters, twelve with food habits, and ten with personal hygiene. Davis worried that the language barrier kept company physicians, nurses, and managers from conveying to international migrants the importance of “careful personal habits and cleanliness” in resisting workplace poisons.²⁷

In some circumstances, company doctors reductively explained the causation of disorders like lead poisoning, where a mix of environmental and behavioral factors could be at work, as simply the fault of the poisoning victim. Alice Hamilton questioned the judgment of her corporate colleagues: “Strangely enough, in the United States both physicians and laymen connected with lead-smelting plants almost invariably lay far greater stress on the danger of uncleanliness on the part of the workman than on anything in his surroundings.” She wondered how men who spent all day “working in clouds of dust … are supposed to get leaded from eating their lunch without washing their hands and faces.” In her autobiography, she recalled employers’ willing embrace of this convenient, medically authorized exoneration: “Many times in the early days I met men who employed foreign-born labor because it was cheap and submissive, and then washed their hands of all responsibility for accidents and sickness in the plant, because, as they would say: ‘What can you do with a lot of ignorant Dagoes, Wops, Hunkies, Greasers? You couldn’t make them wash if you took a shotgun to them.’” In an individualistic society experiencing a massive influx of workers from poor countries, the dominant theme easily became one of patronizing victim blaming. Adding further weight to this perspective was the widespread belief that germ-infected lower-class immigrants threatened the health of respectable native-born members of society. As Mark Aldrich has observed, with the passage of workers’ compensation laws, claims of employee negligence no longer carried legal weight, and it became necessary to rely on education to enforce a sense of victim responsibility. Aldrich also insightfully points out, “No doubt the doctrine that workers were careless … meshed nicely with some employers’ social Darwinian views and ethnic prejudices.” In this context, concentration on personal hygiene often displaced or trivialized industrial hygiene.²⁸

Instruction in the English language was another common component of American welfare capitalism in the early twentieth century. Many leading firms where non-English speakers constituted a substantial fraction of the workforce launched language programs. In a large share of cases, the primary incentive was to give international migrants a new sense of national identity and a willingness to become loyal US citizens. And like all other aspects of corporate paternalism, this one aimed to create loyalty to the employer. But Americanizers in the business world also aimed to promote health and safety by improving workers’ comprehension of written and oral messages. Mobilization for World War I and especially the loss of labor to the military draft intensified interest in any program that helped to conserve scarce human resources.²⁹

Development of workers’ English proficiency attacked a sizable problem. The chorus of commentary in the three state investigations about the difficulties experienced by managers, physicians, and the investigators themselves in communicating with workers in hazardous jobs illuminated a prevalent dangerous situation. In 1911, the US Immigration Commission reported that only slightly more than half of foreign-born employees in manufacturing and mining could speak English. The issue increasingly came to be seen in broader terms: a significant fraction of the immigrant working class was illiterate even in its own native language. Multilanguage warning signs would not reach workers in this predicament. Of the 1,400,000 white immigrants over the age of ten in Pennsylvania in 1910, one-third could not speak English and one-fifth were illiterate in any language. Marion Clark reported in 1918 that only half the approximately 1,600,000 immigrant factory workers in New York could either speak or comprehend the dominant language, and one-quarter were illiterate in their homeland's language. Speaking on “Americanization and Safety” at a state-sponsored safety conference, Clark promoted language training as a “sound business investment” and proposed that every industrial establishment conduct English classes.³⁰

Along with public and private schools and various other institutions, many employers taught English to immigrant workers either during or after working hours. International Harvester Company conducted language classes as early as 1904. American Car and Foundry ran separate night sessions for Italians and Slavs at its Berwick, Pennsylvania, operations, enrolling about two hundred students. The state Department of Labor and Industry promoted the railroad equipment manufacturer's program as “combining Americanization with Safety First.” Solvay Process Company, an upstate New York chemical manufacturer, gave overall control of its Americanization project to its safety engineer. As might be expected, the Solvay project included an English-language component laden with safety messages. Employers’ messages commonly emphasized personal responsibility. One typical lesson for Massachusetts leather workers conveyed this alert: “I must wash my hands and gloves often. If I leave lime on my hands, it will burn me. Handling wet hides makes the floor wet and slippery. If I am not careful, I may slip and fall.” Nineteen of the twenty-four lessons in this teaching guide deal with employee carelessness. If nothing else, pupils in their employers’ courses learned that individual responsibility was central to Americanization.³¹

The Ford Motor Company created the best-known workplace initiative. The firm started its English School after determining that, to communicate effectively with its diverse army of employees, it would have to translate safety materials into forty-two languages. In 1914, Ford brought in Peter Roberts to install an instructional plan for personnel at its main plant in Highland Park, Michigan. Roberts had become a prominent practitioner in the field by inventing a system used at hundreds of branches of the Young Men's Christian Association (YMCA) and numerous firms, including International Harvester. His system proceeded from the premise that in the context of a polyglot and often illiterate workforce, “the only rational solution of the difficulty is to teach all foreigners employed in hazardous industries enough English to enable them to understand simple instruction, to read simple warnings, and to communicate [with] one with another.” His perspective aligned closely with that of Ford management. The company aggressively recruited students for the Roberts program. Inserts in pay envelopes displayed a paternalistic tone: “This School was established for your benefit, and you should be glad of [sic] this opportunity. You must … be able to read the safety signs about the plant. There is no excuse for your remaining away from school.” In three years, this educational intervention cut the share of Ford workers who could not speak English from 35 percent to 12 percent. The automaker's program served as a model for many others. Detroit employers launched an “English First” initiative, sometimes run by company safety committees. The National Americanization Committee seized on the Detroit developments to proclaim that the movements for English First, Safety First, and America First were synergistically interrelated. Far-reaching publicity hailed the sizable decline in workplace injuries since its implementation. In his 1920 overview Schooling of the Immigrant, the product of a study supported by the Carnegie Corporation, Frank Thompson, superintendent of public schools in Boston, lauded the tight focus at the English School: “The Ford classes have emphasized the industrial efficiency aim, such objectives as ‘safety first’ and ability to understand instructions, more than the citizenship ideal.” Workplace language curricula concentrated on prevention of injuries, which were newly covered by workers’ compensation laws, not prevention of illnesses, which seldom received coverage under those laws in the 1910s. Nonetheless, gains in English comprehension gave workers the ability to grasp oral and written warnings about health hazards as well.³²

There was relatively little traffic on Ford's English-only road. Some proponents of Safety First in the business community did reject multilanguage messaging, demanded that all workplace communication be in the dominant American language, and insisted that the foreign-born learn it. A number of members of the emerging cohort of personnel management specialists tested the ability of job applicants to read safety signs and rejected those who failed that test. In 1919, however, when the National Conference on Americanization in Industries, an event attended largely by representatives of industrial companies, voted on the question of requiring employees to attend English classes, the result was one hundred to eight against such a requirement.³³

Public policy in Pennsylvania did embrace the single-language method in one respect. To be sure, in 1913 Pennsylvania enacted legislation requiring that employers alert workers about lead hazards and how to escape them by posting signs in all languages relevant to the composition of their workforce. But in 1917, the state promulgated a regulation requiring that all members of a workgroup, including the supervisor, be able to speak the same language. The main practical meaning of this rule was to force non-English-speaking workers to conform with the language of their English-speaking superior. The Pennsylvania Industrial Board accompanied the issuance of the regulation with a recommendation that employers encourage those lacking English proficiency to enroll in night classes. The Americanization Bureau of the Pennsylvania Council of National Defense supported wartime mobilization by distributing a syllabus that contained a lesson devoted to deciphering warning signs. This privileging of English-language competency reinforced ethnic segregation in the workplace, with bilingual low-level managers overseeing crews composed of immigrants who shared one native tongue. Pennsylvania officials applied this policy to specific health hazards. They gave employers an obligation to warn workers exposed to the dangerous industrial chemical benzene but avoided declaring any duty to communicate in languages other than English. Similarly, when the Industrial Board put forth standards governing the toxic materials used in making explosives, they imposed no obligation for oral or written communication in multiple languages. Notwithstanding the limitations of this stance, a senior official of the Pennsylvania Department of Labor and Industry insisted that “all workers should be cautioned concerning the hazard of their employment and instructed how to avoid this hazard” in discussing industrial disease in 1922.³⁴

Policymakers and public administrators in other jurisdictions departed from the restrictive approach. As previously discussed, the revelations of the investigating commissions in Illinois, New York, and Ohio all immediately brought forth legislative enactments requiring that notices about occupational disease hazards appear in languages appropriate for all those exposed. The AALL's Standard Bill on occupational disease prevention called for this policy. Besides the action taken in Pennsylvania in 1913, at least two other states pursued that strategy as well. The New Jersey legislature in 1914 made employers post signs “in English and in such other languages as the circumstances may reasonably require” that warned of lead hazards and advised as to methods of hazard avoidance. In addition, the law ordered managers to explain the hazards and their avoidance to all employees entering lead-exposed jobs, with “interpreters being provided by the employer, when necessary.” In 1916, the Massachusetts State Board of Labor and Industries moved to protect workers exposed to benzene derivatives and explosives by publishing a regulation that demanded the display of notices “in language intelligible to all the workers.” This regulation required, among other things, that notices identify the common name of the substance present, indicate the signs and symptoms of poisoning, and provide guidance for disease prevention. This modest reform addressed only one category of hazards and thus did not go so far as a plan suggested four years earlier by the health inspector M. G. Overlock. Overlock proposed that Massachusetts officials create a series of leaflets on a range of industrial disease risks, to be “printed in the several languages used by the employees in the different industries” and distributed by unions.³⁵

While encouraging attainment of English proficiency, American firms devised varied modes of communication that went beyond rigid insistence on monolingualism. Both line managers and safety and health staff used various methods to reach their non-English-speaking employees, even when not compelled by law to do so. Foremen and other low-level supervisors learned a smattering of their subordinates’ languages or identified an employee to provide translations of warning messages. Some companies sent English-language literature home with employees and counted on the immigrants’ children to translate it. Films, slideshows, photographs, and drawings helped to surmount linguistic barriers by illustrating hazardous situations and how to deal with them. The Pennsylvania Railroad relied on slideshows and motion pictures to teach safety to its thousands of Italian-born track maintenance workers. In an appeal to company doctors at a 1917 conference, Alice Hamilton explained that “pictures can be understood by all nationalities.” Desperate managers occasionally resorted to gestures or pantomiming to deliver information. The efficacy of these efforts is unclear but was in all probability quite limited.³⁶

Beyond piecemeal actions and makeshift improvisations, some employers of endangered workers undertook substantial programs of multilanguage messaging. Cleveland-Cliffs Iron Company printed the safety rule book given to all workers in English, Italian, and Finnish, as did other industrial enterprises. One chemical manufacturer regularly placed warnings written in English, Italian, and Polish in its employees’ pay envelopes. The Workmen's Compensation Service Bureau put out a reference volume to guide its corporate clients in preparing signs to warn of dangerous gases and fumes “in [a] language (or languages) understood by all employees.” After hearing in 1916 that English-language materials sometimes worked for only a minority of employees, the National Safety Council produced publications in other languages. However, the council's announcement the following year that its bulletin-board literature was now available in seventeen languages received one cold response. Joseph Schereschewsky of the PHS considered it in the best interests of non-English speakers “not to give them the opportunity for perpetuating their native speech but make them understand that now is the time to become true American citizens and learn the language of this country.” Amid wartime patriotic fervor, encouragement of multilingualism was bound to be controversial.³⁷

In addition to varied communication strategies and tactics, many employers in the early twentieth century did recognize the inevitable limitations of attempts to prevent disease and trauma by giving out warnings. These business organizations implemented more systematic hazard controls that sometimes obviated the need for dissemination of hazard information. Rather than rely on delivery of imperfect explanations of risks, enlightened management in some firms strove to reengineer the workplace by installing mechanical ventilation, enclosing hazardous processes, and taking other constructive measures. Less far-sighted managers put in controls when ordered to do so or otherwise encouraged by public authorities. At a health and safety conference in Syracuse in 1917, Royal Meeker, head of the US Bureau of Labor Statistics (BLS), advised explosives manufacturers that “there are mechanical devices … which make it well-nigh impossible for an employee, whether he can read and write and understand the English language or not” to get poisoned by TNT. In his presentation at a 1919 Americanization conference sponsored by the US Department of the Interior, the PHS sanitarian Bernard Newman emphasized technological protections against the threat of occupational diseases, which he contended did more harm to immigrant workers than did traumatic injuries.³⁸

Alice Hamilton passed up no chance to promote engineering controls. Both in conversations in the course of her fieldwork and in her reports for the state of Illinois and then for the federal government, Hamilton emphasized those firms that had redesigned their production technology. Hamilton convinced the Pullman Company to curtail the use of lead-based paints on its sleeping and dining cars, replacing those formulations with innocuous or at least less toxic ones. She noted the phasing out of a process of curing rubber goods that involved the dangerous solvent carbon disulfide. She advertised the installation of enclosed, mechanized equipment and the proliferation of wet methods of dust control in lead smelters and refineries. She thus publicized the existence of effective, practicable control measures. Her reliance on invidious comparisons applied moral suasion to laggard employers. While observing the technological improvements present in most lead smelters and refineries, Hamilton characterized two exceptionally dusty facilities as exhibiting “carelessness in management,” subverting the careless-worker trope so beloved by many in management. Across many industries, ventilation systems swept away airborne gases, dusts, mists, and fumes before they entered employees’ respiratory systems. Increasing substitution of nontoxic materials for toxic ones simply eradicated hazards. From early on, there was in some quarters a recognition that eliminating hazards was better than explaining them.³⁹

Any inclination to overcome communication difficulties by adopting engineering controls faced stiff ideological headwinds. The repetition of unfounded claims that most workplace injuries and illnesses resulted from employee carelessness gave cover to a shortsighted resort to minimal warnings about personal behavior, often poorly understood, that absolved employers of further responsibility. In her classic 1910 study Work-Accidents and the Law, the attorney Crystal Eastman analyzed 377 industrial accidents and discovered that the injured were wholly or partly at fault in only one-third of the cases. Lucian Chaney and Hugh Hanna of the BLS viewed victim blaming as partly “an ingrained notion inherited from the days when the slightest ‘contributory negligence’ barred the victim from recovery” of damages. Chaney added that the worker resented the “fundamental injustice in the emphasis placed upon his share in the responsibility for accident losses.” Yet the conventional wisdom in management circles continued to concentrate on workers’ negligence. In 1917, Arthur Young, director of the American Museum of Safety and a former steel executive, announced that “the general consensus of opinion is that perfection of mechanical safeguarding will contribute not over twenty-five percent of the attainable reduction of accidents.” Young attributed most problems to misbehavior of the worker, whose lapses included “failing to wash dangerous dusts from his hands before eating.” In a 1917 review of chemical hazards, L. A. DeBlois of E. I. DuPont de Nemours and Company acknowledged but downplayed the value of exhaust ventilation and closed systems. DeBlois, who lamented the prevalence of international migrants in his industry, held that in preserving employee health from toxic chemicals, “the greatest factor is undoubtedly personal cleanliness.” From its founding in 1913, the National Safety Council devoted considerable resources to propounding the idea that workers were the main cause of their own difficulties. Victim blaming, which fell with particular force on immigrants and workers of color, undercut corporate decision makers’ willingness to invest in promising engineered protections.⁴⁰

United States Steel Corporation was the world's first billion-dollar corporation at its founding in 1901. It set an influential example of a strategy that attempted to balance technological changes with attempts to increase its employees’ understanding of the dangers of their workplace. Beginning in 1906, this paragon of welfare capitalism expanded and institutionalized its occupational safety and, to a lesser extent, its occupational health activities. The firm created a hierarchical system of safety committees and a central Bureau of Safety, Sanitation and Welfare to oversee the program. Some observers considered this departure to be the commencement of the Safety First movement in American industry. In a discussion in 1912 about health hazards in the chemical industries, the physician W. Gilman Thompson hailed the steel corporation's work as exemplary and urged that its safety plan be adapted to combat health risks. The corporation certainly made no secret of its activities. At the first meeting of the group that would soon become the National Safety Council, the Illinois Steel attorney R. W. Campbell boasted of the work underway. At the same event, Robert Young, manager of the safety operation at the Illinois subsidiary, followed up by describing the actions targeting the roughly three-fifths of the US Steel workforce who were immigrants. In 1913, a member of the Wisconsin Industrial Commission predicted that within a year, almost all of his state's large manufacturers would have set up a safety organization in the mold of nation's largest steelmaker.⁴¹

From the outset, US Steel took a multifaceted approach, with a strong commitment to controlling hazards through investing in engineering measures. But management supplemented those advances with education and training programs. Across its many production facilities, the steelmaker used a variety of means to reach and discipline the sizable non-English-speaking fraction of its force regarding on-the-job health and safety risks. As previously noted, the Illinois Commission on Occupational Diseases applauded the company's deployment of multilanguage signs to warn of carbon monoxide hazards at the Illinois Steel South Works in Chicago. Hiring offices at all sites greeted job applicants with hazard warning signs in several languages. The company printed safety rule books in multiple languages. Management distributed the books to all employees and to priests in immigrant communities. Plant superintendents brought in interpreters to interrogate recently hired employees to determine if their supervisors had instructed them about their job hazards and how to avoid them. Although published only in English, the monthly safety bulletin carried “picture stories” of injury episodes. The firm ran English classes at a number of locations using the Roberts curriculum, which gave considerable attention to safety and health topics. The course offered at the National Tube plant in Lorain, Ohio, featured fourteen safety sessions. The general theme of all these communications was the imperative to avoid carelessness, reinforcing the placement of blame on the victim. In his contention that about 90 percent of accidents stemmed from a lack of care, Robert Young reflected the belief that shaped his firm's perspective and that of others in industrial management.⁴²

In one innovative initiative, US Steel devised and disseminated a sign that aimed to transmit a hazard message wordlessly. The front cover of the August 1912 safety bulletin displayed a large red disk identified as “The Universal Danger Sign.” The company announced that this symbol would now appear “on all warning signs to indicate danger, and for the especial benefit of the foreigner who cannot read. It is hoped this will become as significant as the Red Cross.” This simple graphic marker could warn workers approaching an area with a health or safety hazard to stop and obtain additional information. Although undoubtedly of some utility in alerting illiterate steelworkers, the disk image did not achieve its sponsor's ambition of becoming a universally recognized meaningful symbol, one that rivaled the red cross. The steel industry's trade association, however, did embrace the image. The March 1913 issue of the American Iron and Steel Institute magazine featured a color illustration of a blue warning sign in four languages superimposed over the red disk. The National Association of Manufacturers and the American Museum of Safety promoted the circular symbol.⁴³

The National Safety Council supported what they termed “the red ball” despite misgivings. At the 1916 annual meeting, a working group on danger signs prefaced its analysis with the acknowledgment that a mere warning emblem had severe limitations: “It is not sufficient to advise a man that danger exists, depending upon him to search for the source of the danger which is not always self-evident.” This was a caveat that had particular relevance for minimal warnings about often-invisible health hazards. A survey of the organization's members found that most preferred the skull and crossbones long used on poison bottles. Those in the minority opposed this traditional image and had rejected it as too gruesome; somehow this led the subcommittee on danger emblems to dismiss the majority view. The alternative they proposed incorporated US Steel's red disk, even though the recommendation came after the concession that “the skull and crossbones is undoubtedly the more effective of the two.” The recommendation also took no account of the recent invention and distribution by US Steel itself of an electrocution warning sign that contained the objectionable skull and bones. The council adopted as its official Universal Danger or Caution Emblem a design that placed a red disk within a white diamond with a black border and black vertical and horizontal cross lines. This general warning image achieved less than general or lasting acceptance. By the late 1920s, it appears that even the National Safety Council itself had set it aside.⁴⁴

It is difficult to gauge the effects of the public and private efforts to expand workers’ awareness of workplace hazards in the early twentieth century. The Safety First drive took aim at traumatic injuries, not illnesses. The preoccupation with preventing accidents served to perpetuate the obscurity of threats of occupational disease. But increased attention to injury risks probably served to create a heightened sensitivity to risk, one that extended to disease. Government activity to promote broader knowledge of risks was confined to a few states and to a few severe hazards. In New York, the most ambitious information program of the period had limited impact in the near term. In 1919, the Division of Industrial Hygiene's review of the state's chemical industry came to this unhappy conclusion: “The average workman met with in certain chemical plants, in many cases, knows little or nothing of the nature or effect of the substances which he constantly handles, this ignorance being fostered by some manufacturers for the purpose of protecting their secrets from their competitors, or keeping the men in positions which they would refuse to hold if they realized the dangers of their occupations. Many of the materials are referred to only as ‘dope,’ ‘stuff,’ ‘liquor,’ or by initials which have no relation to the name or real composition of the material.” Without doubt, the dissemination of a limited amount of warning information did not precipitate any significant movement within the working class, or the immigrant segment thereof, for a right to know more about these threats.⁴⁵

For the minority of wage earners with union representation, some attempts to advance knowledge about work-induced disease did emerge during the Progressive Era. In both coal and metal mining, where international migrants comprised a majority of the workforce, organized labor fought for both workers’ compensation and preventive measures to deal with pneumoconiosis in ways that raised consciousness of peril. The Brotherhood of Painters, Decorators, and Paperhangers distributed information on lead poisoning for the benefit of skilled workers in the construction sector. As previously discussed, the International Ladies Garment Workers Union engaged in significant educational activity. Two veterans of the garment workers’ Joint Board of Sanitary Control, Harriet Silverman and Grace Burnham, went on in 1921 to found the Workers’ Health Bureau. The bureau's primary function was to spread knowledge about occupational disease hazards among the membership of local unions. Agitation by the labor movement definitely brought with it some gains in awareness among the rank and file.⁴⁶

The nonunion majority of the working class in the burgeoning manufacturing sector derived knowledge from varied sources beyond what it gleaned from managers’ signs and instructions and government agents’ publications. Experienced coworkers advised new hires in situations where they shared a common language. These veterans also shaped a workplace culture that gave rise to well-understood vernacular terms for occupational disorders. A 1913 reference volume advised that in places where dust inhalation from abrasives caused silicosis and silico-tuberculosis, “‘grinder's rot,’ ‘grinder's asthma,’ and ‘grinder's consumption’ are very familiar terms among the industries using grindstones.” A Catholic priest whose parishioners included many Polish immigrants employed in the grinding department of a local industrial plant wove a bit of epidemiologically based vocational guidance into a sermon. The cleric encouraged these imperiled men to change jobs after observing that the church cemetery already held the remains of four hundred victims of grinding hazards. But in all probability, the main source of enlightenment for workers at risk was an unfortunate belated one—direct observation of their own and their fellow workers’ ailing health.⁴⁷

The strongest evidence of growing awareness among endangered workers comes from their behavior. The most common observable sign of increased knowledge was employee turnover as disease victims and potential victims fled from threats. The very low rates of employee retention in hazardous jobs were, in fact, one of the most frequently noted phenomena of the period. The Massachusetts State Board of Health reported in 1907 that Poles, Greeks, Armenians, and Syrians did not remain for long in tanneries where hides were coated in a nasty mixture of amyl acetate, naphtha, and wood alcohol. Alice Hamilton commented that the lead smelters where many Italian, Greek, and Slavic natives labored experienced monthly turnover of up to 25 percent. In 1916, Hamilton shared with the American Chemical Society her recent inspection of an explosives plant where nitrogen oxide had caused severe respiratory illness among the immigrant labor force. “So many were frightened and quit,” she stated, “that the force used to change about every fortnight.” Her report to the US Department of Labor on the explosives industry as a whole made clear that this was not an atypical situation. She revealed an industry-wide problem of retention among the immigrants and African Americans consigned to the most unhealthful positions. Hamilton also speculated on a perverse information-denying ramification of the turnover problem amid the tight wartime labor market: “In some plants no instruction at all seems to be given, perhaps for fear of frightening away the men at a time when labor is scarce.” Emery Hayhurst's inspectors in Ohio discovered that laborers who produced rubber cement by stirring together benzene, carbon disulfide, and other toxic ingredients in open containers rarely stayed long on the job. “Many workers,” Hayhurst reported, “refused to remain more than a day or two.” Numerous female cigar makers in that state failed to return after one day exposed to nicotine-laden tobacco dust. In Ohio's lime-manufacturing operations, where immigrants and African Americans predominated, “the majority of the workers were of a changing character.” Similar comments recurred throughout this report.⁴⁸

Although the tendency to move on from hazardous jobs contradicted the representation of unskilled immigrants as stupid, nativist disdain colored some responses to this survival maneuver. The new cohort of international migrants was pejoratively dismissed as a “floating population” of drifters. DuPont's manager DeBlois complained that foreign-born employees were “not apt to be steady workers, and all this makes for difficulties in education.” The same prejudice rationalized the mobility of African Americans. Hamilton's visit to a dilapidated white-lead plant in Saint Louis in 1911 elicited this observation: “There seems to be little concern for the health of the men, and it is taken for granted that the majority will quit after a few months. As most of them are Negroes this is attributed, not to illness, but to their natural shiftlessness.” The churning of labor thus reinforced the stereotype of backward peasants and workers of color as too weak and undisciplined for the rigors of the modern workplace.⁴⁹

High rates of turnover cut both ways regarding the growth of hazard knowledge. Employees who departed took away with them whatever lessons they had learned and left their superiors with the chore of educating their uninformed replacements. Managers who witnessed a steady stream of workers exiting their companies had little incentive to advise new employees unlikely to remain on the job very long, thus setting in motion a downward spiral that reproduced ignorance. When sick employees dropped off a firm's employee list, the company's medical professionals were denied opportunities to gather information from physical examinations or visits to worksite clinics. On the other hand, establishments with revolving doors gained unsavory reputations that gave potential employees enough information to act with caution and seek work elsewhere.⁵⁰

Shortly after the publication of the landmark report of the Illinois Commission on Occupational Diseases, Hamilton's friend Florence Kelley asked her to share her insights with the National Conference of Charities and Corrections. Hamilton's review of the human costs of industrialism for this assemblage of social workers captured many of the dimensions of the toll of occupational health hazards. Besides the lack of knowledge exhibited by workers, employers, and others of this “great and sadly neglected problem of our day,” she illuminated the broader reaches of the very general ignorance that prevailed. Her recollection of a visit to one industrial town that relied on recent immigrants cast the breadth of the problem in harsh light: “I do not believe that in any country the distance between peasant and noble is greater than is that between this army of homeless Greeks and Slavs housed in the company shacks of the smelting works, and the American citizen householder of the little town barely a mile away…. Perhaps this isolation of the industrial worker is not the only reason for our ignorance about the diseases of industry but certainly it is one reason.” This Progressive leader saw that the ignorance about workplace hazards that extended to the general public and to her own well-meaning fellow social reformers was a matter of serious concern. This conscientious perspective, with its sense that professional experts needed to take responsibility for the most vulnerable groups in society, colored much of the incipient effort to extend workplace transparency in the early twentieth century.⁵¹