Industry's efforts to protect workers' safety and health in the early 1900s in no way preempted calls for further government action in this field. Progressives were convinced that job safety and health was too important to remain solely a responsibility of employers. Secretary of Commerce and Labor Charles Nagel stressed at a conference on industrial safety in 1911 that "the great enemy of this country is waste" and that "it takes the government to establish the rules of the game" to assure fair play for workers and others who could not protect themselves. The Progressive Party platform of 1912 declared that "The supreme duty of the nation is conservation of human resources" and it called for strong safety and health legislation.130 One of the two new public programs that developed in the Progressive period was "administrative rule‑making," whereby labor departments or industrial commissions could independently issue safety and health regulations without having to go back to the legislature. The other program was the system of pre‑determined fees paid without regard to fault to injured workers or their survivors and, financed from employers' contributions. It was known as workmen's compensation.
In 1884 Germany became the first country to provide compensation to workers injured in accidents. Other countries quickly imitated the German system. In America, the addition continued that workers had to sue their employers for compensation for injuries. It was difficult under common law principles to prove to a jury that the employer was at fault, and the size of awards varied enormously. As juries became more sympathetic to injured workers, and states, under pressure from organized labor, passed laws making it easier to prove an employer was at fault in an accident, the size and frequency of jury awards to workers increased. To avoid the possibly ruinous injury claims, many companies took out expensive employers' liability insurance.
To some critics of this whole system the European workmen's compensation idea seemed an attractive alternative, and numerous articles and government studies about it began to appear. By the early 1900s a few states had passed workmen's compensation laws, but they either failed to survive court tests or were very limited in scope. In 1902 Maryland became the first state to pass a law providing accident compensation regardless of fault, but the law was declared unconstitutional in 1904 by the state supreme court. Further, neither business nor labor was enthusiastic about workmen's compensation, yet.
In 1910 Crystal Eastman's Work Accidents and the Law helped put workmen's compensation in a new light — as a preventive program — and won support for it from business and labor on that basis. After 1908, as we have seen, muckrakers and investigators had begun to arouse public opinion nation‑wide against industrial safety and health conditions. In the opinion of Isaac Rubinow, a leading advocate for social insurance in that period, Eastman's book was "the single strongest force in attracting public and arousing public conscience" on industrial accidents. Eastman's finding that workers bore the economic brunt of accidents even though the largest share of blame for them lay with the employers, was a powerful basis for her argument that if only employers had an economic incentive to eliminate workplace hazards, they would do so. This became one of the fundamental justifications for adopting workmen's compensation.131
The economic incentive to employers was tied to the premiums they would pay to the state or to the insurance company that underwrote compensation payments. Premiums would vary from industry to industry and from plant to plant, depending on the safety record, extent of hazards, and the efforts companies made in accident prevention. The employer would pay a lower rate as safety efforts and the accident record improved in his company or his industry. Supporters of workmen's compensation asserted that the potential savings in premiums would more than cover the costs of necessary safety improvements, making it in the employers' own best economic interest to reduce accident rates. Compensation had the further advantage to employers of substituting the certain but limited cost in premiums for the uncertain but highly variable cost in successful damage suits by injured employees, who would be barred from suing under workmen's compensation.132
Labor was swayed strongly enough to drop strong objections and support workmen's compensation, which it had long opposed. Labor leaders did not want to give up the right of their members to sue employers for damages. Even though success was not guaranteed, awards were sometimes very large. United Mine Workers president John Mitchell was not convinced that employers would eliminate hazards in order to get lower compensation rates. Perhaps most important was the fact that, as John Mitchell put it, workers wanted prevention more than compensation. Labor's efforts had for some years been concentrated heavily on obtaining factory inspection legislation, and compensation was seen as a diversion from this effort. Then around 1909 Samuel Gompers, president of the American Federation of Labor, led the Federation and its affiliates in a historic switch from opposition to support.133
Large corporations did not have the long‑standing dislike of workmen's compensation that organized labor had to overcome and they became strong allies of the compensation movement. At about the same time that they were developing voluntary safety plans, U.S. Steel, International Harvester and several others instituted their own workmen's compensation programs. These large corporations soon realized that smaller companies lacked the resources to start similar voluntary programs and endorsed compensation laws so that all companies would be covered. Two business‑connected organizations gave key support. The National Civic Federation, composed of business and labor leaders, had long supported workmen's compensation, but could do little about it until member Samuel Gompers dropped his opposition to it. After that, the Federation became a center of agitation for workmen's compensation bills. The National Association of Manufacturers, representing the interests of the larger corporations was a strong advocate of compensation. In 1911 the Association studied and was enormously impressed with the preventive efforts associated with the German system instituted by Bismark.134
In 1908 the federal government established a very limited compensation system for its employees which, in combination with the growing movement for compensation as a preventive measure, helped spur the states to action. In 1909 New York, Wisconsin, and Minnesota set up commissions to investigate the question of employers' liability for accidents. Eight states followed in 1910; nine more in 1911. The reports of these commissions showed that most employers were in favor of workmen's compensation. In May 1911 Wisconsin became the first state to establish a workmen's compensation system. Nine other states passed compensation laws that year, three in 1912, and eight more in 1913. By 1921, 46 jurisdictions had workmen's compensation laws in force.135
One of the principal contributions that the Progressive era made to workers’ safety and health was the concept of an industrial commission enforcing safety and health as well as other labor legislation. The industrial commission idea had great appeal in an era when there was much dissatisfaction with the old factory inspection and factory law system, and much debate over just what form factory safety and health laws should take. Some critics had focused on the lack of flexibility in the factory laws, which could only be changed by the legislature. Others had criticized the vagueness and lack of clear guidelines on what was required of employers. The industrial commission idea, whose principal advocate was John R. Commons, took into account both criticisms by proposing an agency that would set highly specific standards, but that could change or revoke them without going back to the legislature for approval. These commissions, Commons pointed out, would be able to develop or utilize specialized expertise and could work continuously, whereas the legislatures had many other concerns and only met intermittently. Crystal Eastman applauded the concept, as did John B. Andrews, who felt that specific rules which were clear to both employer and factory inspector would make factory inspection less subject to the cloud of political influence.
Since the legislature would be excluded from this process once a commission was established, Commons thought it important that the agency regularly consult labor, management and other interested groups before issuing or changing its regulation. Being based on the major facts and pertinent viewpoints, the rules would be less likely to be rejected by courts. Also, employers, it was hoped, would be more likely to accept rules in which their peers had some say.136 John and Irene Andrews agreed, saying:
“In few relations of industrial life is there greater need for complete understanding between the representatives of the various interested groups, than there is in the preparation of a common rule which is calculated to restrict the activities of factory owners and employees or place upon either unusual burdens of legal responsibility.”137
Commons taught at the University of Wisconsin, and it was in that state that the first rule‑making industrial commission was established. It became known as the "Wisconsin idea." Like many other states, Wisconsin had become dissatisfied with its rigid code of factory laws in the early 1900s and was looking for an alternative. In 1907 Massachusetts created a state board of steam boiler rules after two disastrous explosions, with the then novel feature that it set rules on safe construction and operation of boilers without referring to the legislature. The board also held public hearings every six months to hear requests for changes in the rules. The boiler safety board was praised and widely imitated. In 1909 Wisconsin began an experiment of its own in which the bureau of labor statistics met periodically with labor and management representatives and insurance experts and developed a set of voluntary factory safety rules. Prof. Commons put his students to work studying labor law administration in Germany and other countries which had adopted the administrative regulation method. Commons helped draft a bill to establish an industrial commission in Wisconsin in 1911 and, with the support of progressive elements dominant in the legislature, it was enacted.138
The Wisconsin Safe Place Statute of 1911 embodied the basic ideas expressed in the Massachusetts boiler safety board and espoused by Commons and others. It was widely imitated. The law required employers to furnish employment and a place of employment, in which workers' lives, limbs, health and comfort would, within reasonable limits, be protected. An industrial commission was established whose principal powers were:
“To investigate, ascertain, declare, and prescribe safety devices, safeguards, or other means or methods of protection best adapted to render the employees of every employment ... safe .... To ascertain and fix such reasonable standards and to prescribe, modify, and enforce such reasonable orders for the adoption of ... means or methods of protection.”139
The commission's orders became law 30 days after they were published. Labor, management, and other interested groups were included in the rule making in two ways; through open hearings on proposed rules or changes, and through representation on advisory committees that drew up and reviewed rules the commission proposed to adopt. Commons, who served on the commission for its first two years, from 1911 to 1913, experienced first‑hand the advantage of not having to get labor unions and other groups together and go back to the legislature when it was found that projecting set screws or some other hazard had been omitted from the safety laws. In 1913, six states established similar industrial commissions, and by 1936 administrative rule making had become the dominant form of state regulation of job safety and health.140
Like factory inspection in the 19th century, Progressive reforms had a substantial effect on workers' safety. Voluntary programs were far from universal throughout industry, but where adopted were successful. Workers' compensation had relatively little effect as a financial incentive, but insurers pressed companies to workplace hazards. Administrative regulation, while slower and less flexible in operation than expected, was still a definite improvement over cumbersome, purely legislative regulation.
Safety drives in the steel, various agricultural implements, and certain other manufacturing industries built impressive records. Safety pace setter U.S. Steel reported that "where open gears were the rule a few years ago, everything is now smoothly covered." The corporate safety committee received 6,000 safety suggestions and adopted 90 percent of them. As a result, accident rates declined a dramatic 43 percent after just a few years and the company estimated that it had saved 2,000 men from death or injury each year. Soon other steel companies imitated U.S. Steel and produced equally impressive results. Inland Steel quickly reduced accident rates by 55 percent, Jones and Laughlin by 71 percent. A steel industry‑backed "Safety First" movement developed after 1910, gained broad support and led to the establishment of the National Safety Council in 1915.141
Administrative rule making did not completely supplant the earlier factory legislation or solve the problems associated with it. Nor was the new system free of shortcomings. The difficulty of providing competent inspection did not disappear. Furthermore, this system was often very slow in producing safety codes, and some of the rules obtained were no more specific than the factory laws they superseded. However, John Andrews noted in 1936 that since 1911, the most important legislative activity on labor matters in the states had been in the area of administrative regulations. Of that, "the most extensive development ... occurred in the field of industrial hygiene." The "Wisconsin idea" also provided the model for comprehensive federal regulation of workers' safety and health beginning in 1970.142
Expectations were high that workmen's compensation legislation would provide a potent tool for the prevention of industrial accidents. Insurance premiums were somewhat lower for safer workplaces under the "merit rating" system used by many insurance companies. However, this did not provide a real economic incentive for employers to make greater efforts to reduce accidents. The average rates were so low that it made little financial difference to an employer whether he had a good or a poor safety rating. On the other hand, inspectors for insurance companies helped employers eliminate unsafe practices and conditions. Steel and machinery firms redoubled their safety programs after passage of workmen's compensation. In 1912, the Wisconsin Industrial Commission hired a safety expert from International Harvester to help other employers set up plant safety programs. Other states adopted this approach and an alliance began to develop between industry and state government in the safety field. In short, workers' compensation compelled employers, perhaps more than any other state legislation, to consider the need to prevent accidents.143
In addition to a three‑pronged movement focused largely on industrial safety, there was a sharp increase, during the Progressive period, of interest in occupational health. Some progress had already been made in the 19th century in understanding and controlling occupational illness. In 1837 Benjamin McCready published a textbook on the subject, but it was one of a very few. As early as the 1830s, workers had protested unhealthy conditions in New England textile mills. Factory laws usually included provisions for ventilation and a few states passed laws on such specialized problems as preventing the "bends" in caisson workers. Some state labor bureaus studied illnesses, although statistics on mortality and illness rates were very poor. Many Americans in the 19th century clearly recognized the existence of health dangers in the workplace, but efforts to deal with them had only limited success.144
The first major public attempt to investigate occupational disease in general was done by a special occupational disease commission established by the state of Illinois, which published its results in 1911. This pioneering commission, created in 1907, grew out of the recommendations of the Illinois industrial insurance commission and of Charles Henderson, a sociologist at the University of Chicago who was studying Germany's sickness insurance system for workers and who favored such a plan in this country. The commission was composed of governmental labor and health officials, physicians, and other interested citizens. It was to "thoroughly investigate causes and conditions relating to diseases of occupation" and recommend remedial legislation. In a preliminary report in 1909 the commission summarized a sampling of hazards in the metal trades, glass trades, brick and stone works, and other dusty trades, in an effort to make people more aware of "the vastness and complexity of the problem." The commission noted that it had covered only a small portion of the field and declared that "Justice to the public health and welfare and to the workmen... demands a continuation of the investigation which we have only begun." The legislature agreed and the commission's life was extended to 1911.145
In the meantime, Alice Hamilton, a young reformer and medical researcher living in Chicago, was developing an interest in the neglected field of occupational disease that would lead her to pioneering work with the Illinois commission. The sister of the famous popularizer of mythology Edith Hamilton, Alice had taken a medical degree and was doing settlement work at Jane Addams's Hull House in Chicago. Living among working‑class people, Hamilton's interest in industrial diseases was aroused by "tales of the dangers that working men faced, of cases of carbon monoxide gassing in the great steel mills, of painters disabled by lead palsy, of pneumonia and rheumatism among the men in the stockyards." A tragic fire at a pumping station in Lake Michigan in which many men were killed shocked Alice. It prompted her to look more seriously into the area of occupational health hazards in the medical literature. To her surprise and disappointment, she found almost nothing on the subject in the American journals, although the European ones had a great deal of material. She discovered that American medical experts did not consider industrial disease a serious problem in this country and the subject was not deemed "respectable" in the profession.146
When the occupational disease commission was renewed in 1909, Hamilton was asked to join it as a member, but she chose instead to be its chief researcher. She headed a staff of 20 volunteer scientists, physicians and others. The University of Chicago and several medical institutions and libraries allowed the commission free use of their facilities. In addition, the U.S. Bureau of Labor and several labor unions and corporations assisted in various portions of the study. The preliminary report in 1908 had listed 30 known toxic substances. The scope of the later investigation was narrowed down to a more manageable range of selected hazards and maladies, including lead, brass, mercury, arsenic, carbon monoxide, caisson disease and deafness. Hamilton personally took over the studies on lead, mercury and arsenic, in addition to overseeing the rest of the investigators. They all had to start virtually from scratch, as there were no lists of the trades in which a particular danger was to be found. Hamilton and the others started with known unhealthy trades, in the hope these would lead to others. Years later, Hamilton looked back on the Illinois commission's work as "exciting and rewarding" and a "voyage of discovery."147
The final report of the commission covered a number of hazards, but Alice Hamilton's section on lead poisoning was the most thorough and important. Hamilton found dangers from lead poisoning in many trades, among them lead smelting and refining, making white lead pigment, painting, printing, and making storage batteries. In one interesting bit of detective work, she followed up on a case of lead poisoning that she found in a hospital and traced the lead exposure to a sanitary‑ware enameling plant — an industry not previously considered a source of lead poisoning. Hamilton found two forms of lead danger: airborne particles inhaled into the lungs and particles ingested because of lead‑contaminated hands or food. She came across hundreds of cases of lead poisoning. In one enamel ware plant, out of 148 men she examined, 92 were definitely or probably "leaded."148
Many of the lead workers Hamilton studied were foreign and had no idea of what they were getting into. A young Bulgarian immigrant took a job in a white lead factory and was put to work emptying pans of the dry powder. He was not given a respirator and did not know to ask for one: "Nobody told him the white dust on his hands and mustache was poisonous." After only five weeks on the job he suffered a severe attack of lead poisoning. A Russian Jewish immigrant made red lead paste in a storage battery factory. As he moistened his fingers in his mouth he had no idea he was ingesting a dangerous substance and became severely poisoned after ten days work. Hamilton found "almost no effort in the lead works to instruct the foreigners ... in the avoidance of danger."149
The Illinois commission on occupational disease helped establish the problem of industrial disease as a matter for public concern and helped to alleviate the problem in a number of ways. In its final report, the commission recommended proper ventilation, temperature and humidity control, and sanitary measures, which would lead to more healthful workplaces. It also stressed the need for special protections for women, children and other groups considered especially vulnerable. A draft occupational health law was included in the report, similar to earlier factory acts and aimed particularly at protecting workers in the lead trades. The bill also would have required employers to notify workers of dangers with posters in their native language. This bill was introduced in the Illinois legislature but did not pass. However, another, somewhat less inclusive bill that followed most of the commission's recommendations was successful and became the Illinois Occupational Disease Act of 1911.150
An important side‑effect of the commission occurred when it sent Alice Hamilton to an international conference on occupational disease held in Brussels in 1910. The only other American on the program was Charles P. Neill, U.S. Commissioner of Labor. When they met, Neill was very impressed with Hamilton. After she finished her work with the Illinois commission he invited her to do a series of investigations in industrial health for the Bureau of Labor. Hamilton's work with the commission launched her on a career in industrial medicine and she is regarded as the founder of the American branch of that discipline.151
Occupational health found a champion at the national level in the American Association for Labor Legislation (AALL), a lobbying and research group founded in 1906 by Richard T. Ely and John B. Andrews. The AALL soon focused most of its resources on eradicating occupational hazards, particularly those affecting health. Ely explained in 1909 that industrial health was a problem that appealed to all, even children, and that enforcement of laws on this would have the best chance of success in the courts. In the AALL’s legislative strategy, industrial health and safety laws were to secure a beachhead for the enactment of other labor legislation.152
An ideal vehicle for dramatizing occupational health existed in the match industry in the form of phosphorus necrosis. "Phossy jaw," as it was known among the workers, was a horribly disfiguring disease that frequently attacked the teeth and jaw‑bones of workers handling white phosphorus in match factories. Particles that got into their mouths attacked decayed teeth and the disease worked progressively to the jawbone. It caused intense pain, enormous swelling in the face, and, in some cases, death. The main treatment was removal of the diseased tooth and bone. Some unfortunate victims lost their entire lower jawbones and were disfigured for life, though the men sometimes grew beards to try to disguise their handicap.153
In 1909 John Andrews undertook a campaign to eliminate phossy jaw. Beginning under the auspices of the AALL before later obtaining a contract with the U.S. Bureau of Labor, Andrews investigated 15 match factories across the country and isolated 100 cases of the disease. The Bureau, which had already put out several reports on occupational health after 1900, published the Andrews study in 1910, complete with photographs of the grotesquely distended faces of victims.154
After his report came out, Andrews led an unprecedented effort to lobby Congress to prohibit the use of white phosphorus in making matches. Phosphorus necrosis had long been recognized in Europe as an occupational disease and the poisonous white phosphorus had been banned in many countries. The U.S., which had refused to sign an international agreement on the toxic substance, was now pressured into action. In 1912 it passed the Esch Act which protected the 3,000 workers affected by placing a prohibitive tax on white phosphorus matches. The Diamond Match Co., which had a patent on a harmless substitute, generously waived its exclusive rights and made the substance available to all.155
With examples like the Andrews crusade against phossy jaw and the Illinois Commission on Occupational Disease pointing the way, the decade from 1910 to 1920 saw a transformation in the prevention of occupational disease. The American medical science profession turned to the subject with great interest. Specialists in physiological chemistry and other areas studied morbid effects of diseases on the body. Andrews' victory over phossy jaw strengthened the growing belief that public concern over industrial disease could be kindled, economic roadblocks removed, and a coordinated effort by scientists and social activists achieved.156