Hamilton and Hardy: Mentoring and Friendship in the Service of Occupational Health

Overview of Professional Accomplishments

Alice Hamilton (1869-1970) is well known as “the mother of occupational health.” She played a key role in developing the field of occupational health in the United States in the first decades of the 20th century at a time when immigrants were streaming into the country to fill jobs in factories and mines, and few workplace protections were in place. ³ Hamilton carved out a unique style of investigation of occupational health threats that was interdisciplinary and grounded in the experience of workers themselves, ⁴ frequently visiting the mines, smelters, and factories where workers became ill or died to learn how to prevent future illnesses. ⁵ She published seminal texts on industrial toxicology, authored key government reports and numerous academic papers, and was the first woman appointed to the faculty at Harvard University. In the era before federal occupational health legislation and effective state legislation, she used her powers of persuasion to convince managers to clean up the work environment. As the leading expert on occupational lead poisoning in the United States in the early 20th century, she was outspoken about lead’s toxicity, and she urged precaution in the use of lead in paint and gasoline. ⁶ She sought ways to advocate for workers’ health in the face of the growing power of American industry, maintaining a clear focus on science and prevention. ⁷ Hamilton’s intellectual curiosity, sense of precaution, deep commitment to protecting health, interdisciplinary thinking, and strong moral compass make her a model for the engaged public health researcher, even today.

Harriet Hardy’s (1906-1993) contributions to occupational health include tangible ones, such as more than 100 publications in the course of her career. Her writings spanned many industrial hygiene and occupational health issues, including toxicity from lead, mercury, asbestos, and cadmium; radiation; occupational lung disease; and treatment of occupational illness. ⁸ Hardy is best known for her work identifying and studying beryllium exposure and its sequelae. She started the National Beryllium Registry, described as “one of the first registries to collect long-term data on a chronic health disorder.” ⁹ Because she was a leading expert on beryllium disease, she became a consultant for the Atomic Energy Commission (AEC), where she is credited with “infusing public health values into a culture of secrecy.” ¹⁰ She was an internationally recognized expert in occupational medicine, and she educated generations of students. Less tangible are the ways in which she shaped the field philosophically. At a time when occupational health was becoming increasingly specialized and technical, she held fast to the idea that learning from the experiences of workers was critical. Throughout her career, she advocated her guiding principles—that healthy people should not be made sick by work and that prevention was paramount. She thought physicians should play a leading role in keeping workers healthy, and she advocated for the medical field to embrace occupational medicine in the training of physicians. ¹¹

Their Professional Accomplishments in Context

Looking back from today’s vantage point, it is extraordinary that the first edition of the American text on occupational hazards and diseases in the 20th century was written by one female physician-scholar and the second edition by two female physician-scholars, at a time when few women held academic appointments in US universities, and few women were trained as physicians. Elizabeth Blackwell was the first woman to graduate from a US medical school, in 1849. When Hamilton graduated from medical school in 1893, women were still severely underrepresented in the profession; about 4% to 6% of all physicians in the United States were women, a percentage that did not substantially change until the 1970s. ^12,13

For Harriet Hardy, entering academic medicine almost 3 decades after Hamilton, it was probably not much easier. Hardy held several academic appointments at Harvard, Massachusetts Institute of Technology (MIT), and elsewhere. At MIT, a woman was not tenured until 1963, ¹⁴ and even today only a small percentage of tenured engineering and science professors are women. ¹⁵ In addition to her academic appointments at MIT (1951-1954, 1961-1962), she was the assistant medical director of MIT’s Occupational Medicine Service (1949-1971). ¹⁶ Her key appointments at Harvard included instructor in the Department of Industrial Hygiene, Harvard School of Public Health (1947-1952), and various appointments at Harvard Medical School beginning in 1955, culminating in a full professorship in 1971 (the second female full professor at the medical school). ¹⁷

The Beginning of the Collaboration

When they began their collaboration in 1946, Hardy was aged 40 and Hamilton was aged 77. Hardy was then employed at the Massachusetts General Hospital and the Massachusetts Department of Labor and Industries. ¹⁶ Hamilton must have understood the importance of her invitation to Hardy to be her coauthor. Hardy at the time was early in her research career, having published 5 academic articles, only one of which concerned occupational health. That article, a case series of 17 workers who developed “chemical pneumonitis” in a fluorescent lamp factory after exposure to beryllium, published in 1946, ¹⁸ was notable because it was among the first in the United States to implicate beryllium exposure in lung disease in the fluorescent lamp industry. According to Hardy, Alice Hamilton read the paper, wrote to congratulate her, and shortly thereafter asked her to coauthor the second edition of Industrial Toxicology. ¹⁹ Hamilton wrote, “You could start in right away on beryllium and cadmium.…I expect to be in Boston for ten days or so following Thanksgiving Day and we can have any number of conferences. You see, I am writing as if you had already accepted. I do hope you will.” ²⁰

For Hardy, Hamilton’s invitation to coauthor the wide-ranging text was an opportunity both to gain mastery of the literature on occupational health hazards and to list her name alongside the most accomplished, effective, and well-known occupational health practitioner in the United States at the time.

Hamilton and Hardy had much in common as physicians passionate about the health of workers. Hamilton was drawn to occupational health because of her concern for the health problems of the poor. Her feelings had been shaped and honed in the late 1800s and early 1900s by living and doctoring at Hull House in Chicago, where she witnessed and tended to many maladies and saw the steep toll of occupational illness and injury in the neighborhood’s immigrant population. ⁴

Hardy, who earned her medical degree at Cornell University Medical College in Manhattan in 1932 and treated patients on the Lower East Side during the Depression, was also exposed to the struggles of workers and the injuries and illnesses linked to occupation during that time. ¹⁹ For example, one of the most significant occupational health disasters in the nation’s history, the Gauley Bridge disaster, occurred in the early 1930s, when more than 700 workers died from silicosis caused by inhaling silica dust while drilling the Hawk’s Nest tunnel in Gauley Bridge, West Virginia. ²¹

Hamilton’s Professional Support to Hardy

The professional relationship between the 2 women started through the writing of Industrial Toxicology and then grew and flourished during subsequent decades. From the mid-1940s until Hamilton’s death in 1970, the women wrote letters to each other and visited each other frequently. One striking aspect of their correspondence was the consistent professional support that Hamilton gave to Hardy. Throughout their friendship, Hamilton often provided career advice and helped Hardy to navigate the trials and tribulations of academia.

Hamilton was always quick to praise Hardy’s accomplishments and to spur her onward. For example, during the writing of Industrial Toxicology, Hamilton called Hardy’s chapter on radioactivity “outstanding” and wrote, “I am so full of admiration that I must write you at once and tell you.” ²² When Hardy was exploring a position with the AEC and wrote that she was visiting Los Alamos in 1947, Hamilton responded encouragingly: “[Y]ou are certainly on the path to an important and successful career, which you deserve.” ²³ When she was offered the job, Hamilton assured her that it would be good for her career and win her prestige in the field. She wrote, “I feel certain you have a brilliant career before you.” ²⁴ When Hardy was appointed to the MIT faculty in 1951, Hamilton wrote, “It is splendid that you are to teach at M.I.T. You certainly do forge forward all the time and this is one of the most gratifying of all your successes.” ²⁵ And when she received an appointment to the Harvard Medical School faculty in 1955, Hamilton wrote, “It is grand that you are at long last on the Harvard faculty. But don’t let them make too many demands on you.” ²⁶

Hamilton also celebrated Hardy’s publications. In 1951, Hardy published a sole-authored comprehensive overview of the state of knowledge on beryllium poisoning in US industries in the Proceedings of the Royal Society of Medicine. ²⁷ On this occasion, Hamilton wrote, “I am immensely impressed by the reprint of your article in such a grand journal.” ²⁸

For her part, Hardy sought career advice from Hamilton. When planning travel in 1950, Hardy asked Hamilton which researchers in occupational health “in this country you consider important to see at work” ²⁹ and asked what kind of work to prioritize among many competing demands. ³⁰ Hamilton told Hardy, “I rather think I would give preference to the clinical work at the M.G.H. [Massachusetts General Hospital],” likely because Hamilton thought this was an area of weakness that she herself experienced: “[A]ll my professional life in the field [of] industrial toxicology I felt lack of just that, and I know it hampered me in many ways.” ³⁰

Hardy also sought Hamilton’s advice about publications, asking which presses would be best to work with and which of several writing projects to pursue. ³¹ The career issues for which Hardy sought advice from Hamilton were those that were critical to success in academia. That Hardy turned to Hamilton for this type of advice tells of the important role Hamilton played in Hardy’s professional development.

Hamilton’s professional support at times assumed a motherly tone, as she reminded Hardy to take care of her health and to not overwork herself so that she could have a long and productive career. In one letter she wrote, “Don’t overdo. Years ago Professor Edinger of Frankfurt-am-Main told me that American men of science seldom if ever did goodwork [sic] after they were fifty, because they wore themselves out.…So go slow.” ³⁰

Hamilton did not only offer support, however. She was at times critical of Hardy’s work with the AEC. When Hardy wrote to Hamilton in 1952 that she would be traveling to New Mexico, Hamilton responded, “New Mexico means Los Alamos I suppose. I wonder what you are up to there. If only all those workshops of the Devil could be pulled down. But instead we are building bigger ones.” ³²

Despite occasional criticism, Hamilton encouraged Hardy to live life to the fullest and to take advantage of professional opportunities. In a 1951 letter, in response to Hardy’s news that she had been invited to Portugal, Hamilton wrote, “Do go to Lisbon. At your age you should not turn down any chance to do something interesting and unusual. As I look back over my life I have no regrets over the adventures but many over the failure to embrace adventures.” ³³

Navigating the Politics of Occupational Health

Academic occupational health in the United States in the 1940s, when Hardy entered the field, was only 2 decades old. The department in which Hamilton and later Hardy taught at Harvard (then the Department of Industrial Hygiene) was among the first such departments in the United States. According to historian Christopher Sellers, as a formal academic discipline, the field at Harvard evolved away from Hamilton’s pragmatic factory inspection approach, to a highly specialized, technical, laboratory-based field. The development of occupational health as a scientific field of academic study led to formal alliances with industry for funding, and, as Sellers explains, the knowledge gained from these studies would often be hidden from workers. ⁶ This relationship between academia and industry was one important aspect of the politics of the field that Hardy had to navigate, and she turned to Hamilton for advice. In one instance in 1955, she wrote the following to Hamilton:

I wish when you write to me some day you would tell me whether I should continue to try and find someone on the management side of industry and simply let him know of the work I want to do at the General [Massachusetts General Hospital], or whether I had better forget it. I don’t want to be foolish about this point, but I am very keen to keep my studies at the hospital entirely neutral. ³⁴

A consistent frustration for Hardy was what she saw as the limited involvement and influence of physicians in the field of occupational health. After lunch with a mutual friend, Dr May Mayers of the New York State Department of Labor, Hardy wrote to Hamilton about their discussion of power relationships in the field: “Dr. Mayers says that industrial hygiene at the moment is completely or nearly so in the hands of management, and that the government agencies have very little voice in this Country, and she agrees with me that the doctor is the smallest voice of all.” ³⁴

Evolution of the Mentoring Relationship

As Hardy’s authority and seniority in the field increased, their professional relationship deepened into a friendship that lasted until Hamilton’s death in 1970. Hamilton and Hardy shared confidences about their own health, personal worries, and concern for ailing family members. Arranging a meeting with Hamilton while she was in Boston, Hardy wrote, “There is, of course, as usual so much to say that I hope perhaps we can meet more than once.” ³⁵ When Hamilton was unable to receive an award and Hardy received it in her stead, Hamilton wrote, “Of course you were the one to accept the award for me. Nobody else is so closely associated with me.” ³⁶

When Hardy had a health scare about a possible malignancy and told Hamilton only afterward, Hamilton was alarmed that Hardy might have had to deal with this brush with mortality alone. Hamilton asked, “Did you have anyone close enough to share it with you? I don’t believe you did. I think you bore it alone.” Hamilton took her to task for leaving the hospital too early after surgery, gently called her decision “reckless,” and asked her if she was “being careful enough?” ³⁷

Hamilton, who lived to be 101, not infrequently brought up her longevity in letters to Hardy. She appears to have thought often of her own death and revealed these thoughts to Hardy. For example, after Hardy’s health scare she wrote, “I am interested in what your experience was facing possible death…of course with me it is certain death. Only how soon? So that I live with it always at the back of my mind.” ³⁸

Although Hamilton easily and fluently described her inner feelings and personal struggles in her letters, Hardy was more reticent to turn toward the personal, but would do so on occasion. In a rare direct expression of her feelings toward Hamilton, Hardy wrote, “I think it is rather pleasant to have one’s colleagues nearby and my association with you has certainly given me the greatest pleasure and satisfaction.” ³⁹

Parting Thoughts

The relationship between Hamilton and Hardy was professional and personal, intellectually rich, and emotionally supportive. Hamilton’s invitation to Hardy to coauthor Industrial Toxicology helped to launch Hardy’s career in occupational health. That Hamilton turned to Hardy as a coauthor rather than to a well-established male researcher is laudable. Even today, their story is inspiring for well-established senior researchers, demonstrating how collaborating with junior women or members of underrepresented minority groups can help them to advance their careers. The mix of tangible professional and personal support that Hamilton gave to Hardy provides a model for women supporting women in academia, medicine, and public health.

It is remarkable that Hamilton and Hardy became leaders and collaborators in occupational health before women had a strong presence in academia. Hamilton possibly realized that the best she could do in a male-dominated field was to use her hard-won prestige and status to elevate a female researcher. Hardy in her own right was a talented physician, researcher, and academic. Hamilton supported her in carving out a significant and respected place early on that she continued to shape and mold with hard work, commitment, and perseverance. Important to their successes were professional and personal relationships, particularly with other women, in which they found support for their work, their development as professionals, and an outlet to gain support and perspective on inevitable personal and professional challenges and struggles.

Mentoring relationships with established scholars are important to the success of female academics, including their facility with publishing, earning promotion, and competing for external research funding. ⁴⁰ Yet a recent study suggests that women still face barriers to informal mentoring in academia and that academics are more likely to offer to mentor students who are white males, symptomatic of ongoing gender and racial bias in academia. ^41,42

Young women academics need “Alice Hamiltons,” and senior women need to be “Alice Hamiltons”—senior women who combine tangible support, offers of collaboration that launch junior scholars, and the personal friendship and encouragement that contribute to professional success and make meaningful work even more enriching for ourselves and for society.