Occupational Health in the U.S. Army, 1775–1990 Chapter 1 OCCUPATIONAL HEALTH IN THE U.S. ARMY, 1775–1990 JOEL C. GAYDOS, M.D., M.P.H.* INTRODUCTION THE CIVILIAN WORKER IN WORLD WAR I Gas Production and Gas Protection Plants Munitions Industries THE CIVILIAN WORKER IN WORLD WAR II The Army’s Responsibility for Employee Health Expanding the Industrial Medical Program Organizational Advances in Providing Occupational Health Services THE OCCUPATIONAL SAFETY AND HEALTH ACT AND THE U.S. ARMY Occupational Health Programs at Army Installations The Occupational Health Management Information System Overseas Programs THE INDUSTRIAL SOLDIER MILITARILY UNIQUE EXPOSURES The Early Years World War I Between the Wars Special Laboratories During World War II Weapons Modernization in the 1980s CHEMICAL WARFARE Demilitarization Production of Binary Chemical Weapons Contemporary Threats Medical Education Ethics ENVIRONMENTAL HEALTH Mission and Organization Environmental Program Initiatives SUMMARY *Colonel, U.S. Army; Associate Professor and Director, General Preventive Medicine Residency Program, Department of Preventive Medicine & Biometrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799 1 Occupational Health: The Soldier and the Industrial Base INTRODUCTION Occupational health applies the disciplines of were few.2,5 Alice Hamilton, M.D. (1869–1970), the medicine, biology, epidemiology, engineering, eco- pioneer who established occupational health as a nomics, education, politics, and the law to protect specialty in medicine, described early 20th-century workers from hazards in the workplace.1 The army’s conditions (Figure 1-1): occupational health effort, the U.S. Army Occupa- tional Health Program, has a set of defined goals American medical authorities had never taken in- and objectives and is accompanied by a plan and the dustrial diseases seriously, the American Medical resources necessary to achieve success. Association has never held a meeting on the sub- Diseases and the injuries associated with pro- ject, and while European journals were full of ar- ticles on industrial poisoning, the number pub- ductive labor accompany human history. Pliny the lished in American medical journals up to 1910 Elder (AD 23–70), a Roman scholar, recommended could be counted on one’s fingers. that workers wear masks to prevent inhaling dust and fumes. Georgius Agricola (1494–1553), a Ger- For a surgeon or physician to accept a position with a manufacturing company was to earn the con- man physician, wrote a classic volume describing tempt of his colleagues as a “contract doctor”; as for the diseases and accidents that befall miners and factory inspection and control, we never discov- ways to prevent those diseases. The father of occu- ered a trace of it. pational medicine, Bernardino Ramazzini (1633– 1714), studied and practiced in Italy. His treatise on This ignorance and indifference was not confined to the medical profession—employers and workers working conditions and occupational diseases in- both shared it. The employers could, if they wished, cluded diseases of military service (De Morbis shut their eyes to the dangers their workmen faced, Castrensibus) and cautions, or preventive measures. for nobody held them responsible, while the workers Ramazzini is credited with formulating the ques- accepted the risks with fatalistic submissiveness as tion that must be asked about every patient: “What part of the price one must pay for being poor.6(pp3–4) occupation does he follow?”2–4 The long-standing interest in Europe in workers’ The development of the U.S. Army Occupational health had no parallel in the United States. Massa- Health Program and the civilian occupational health chusetts created this country’s first factory-inspec- movement were closely related. Military program tion office in 1867, and the Knights of Labor, a labor efforts were directed primarily at (a) the army’s group formed later during the 19th century, fought civilian worker in the industrial setting, (b) the for health and safety measures in mining and other soldier in the industrial setting, and (c) the soldier industries. Noteworthy achievements, however, with militarily unique exposures. THE CIVILIAN WORKER IN WORLD WAR I U.S. Army Medical Department (AMEDD) involve- Gas Production and Gas Protection Plants ment with civilian-employee health programs began during World War I because poisonous military Gas-defense equipment was procured under con- chemicals were being produced and used on the battle- tract, but the U.S. Army’s Office of The Surgeon Gen- field.7,8 After the German army launched an effective eral (OTSG) had to build and supervise its own plant chlorine gas attack against French and Canadian troops to manufacture items that were not available commer- in 1915, army medical officers were assigned to the cially. To develop and test procedures for gas defense, British and French armies as gas warfare observers some AMEDD personnel participated in experiments and reported their observations on gas defense. As a and training exercises that dealt with the use of poi- result of the army’s concern about gas defense, and sonous gases in warfare. The OTSG quickly became possibly related to the observers’ reports, AMEDD was convinced that all soldiers and civilian workers who assigned the mission to furnish gas masks and other might be exposed to poisonous gas in any setting, gas-defense equipment to the army. Later, this mission including gas factories, must be provided protection was transferred to the Chemical Warfare Service.9,10 and medical care. Lacking expertise in providing 2 Occupational Health in the U.S. Army, 1775–1990 Fig. 1-1. Dr. Alice Hamilton was so impressed by the morbidity and mortality associated with occupational exposures that she devoted her professional life to the practice of occupational medicine. This occurred at a time when American physicians knew nothing about this field or showed little interest in it. Dr. Hamilton was also a pioneer in other respects. After she received her M.D. degree in 1893 from the University of Michigan, she studied in Europe and at The Johns Hopkins University in Maryland; taught pathology at the Woman’s Medical School, Northwestern University, in Chicago; and in 1919 became the first woman faculty member at Harvard University. Photograph: Reprinted from United States Public Health Service. Man, Medicine, and Work. Washington, DC: USPHS; 1964. Publication 1044. 3 Occupational Health: The Soldier and the Industrial Base protection against war gases, the OTSG obtained as- The first beehive coke ovens in the United States sistance from the U.S. Bureau of Mines (Department were built in southwestern Pennsylvania in 1841 to of the Interior), several major universities, and the produce coke from coal for iron and steel production Marine Biological Laboratory at Woods Hole, Massa- (Figure 1-2).12 During the early years of World War I, chusetts. A collaborative program with the Bureau of American industries, especially those dealing with Mines for supervising the sanitary supervision (health coke by-products, had to reconfigure to produce dyes, and safety evaluations) of government- and contrac- aniline (needed to make dyes and rubber), and nitric tor-operated gas factories resulted from this effort.10,11 acid (needed to make munitions). Dr. Hamilton, working for the Department of Labor, conducted in- Munitions Industries spections of these factories.6 Sometimes canaries (work- ers stained yellow with picric acid) led her to the Because American manufacturers had previously plants; at other times she located the industrial sites relied heavily on the German chemical industry, they lacked experience in producing (and protecting their by the great clouds of yellow and orange fumes, workers against) not only chemical warfare agents nitrous gases, which in those days of crude proce- dure rose to the sky from picric-acid and nitrocellu- but also many of the other chemicals needed for lose plants. It was like the pillar of cloud by day wartime use. Additionally, even though American that guided the children of Israel.6(p184) manufacturers were concerned about preventing ex- plosions in their plants, they had no interest in the Both Dr. Hamilton and army sources document toxicity of industrial chemicals, particularly unfamil- occupational exposures in the munitions industry as iar ones like picric acid and trinitrotoluene (TNT). causes of morbidity and mortality.6,13 In a 1917 report, Figure 1-2 is not shown because the copyright permission granted to the Borden Institute, TMM, does not allow the Borden Institute to grant per- mission to other users and/or does not include usage in electronic media. The current user must apply to the publisher named in the figure legend for permission to use this illustration in any type of publication media. Fig. 1-2. The first beehive ovens in the United States were built in southwestern Pennsylvania in 1841 to produce coke from coal for iron and steel production. Near the turn of the century, spurred by the loss of products from the German chemical industry during World War I, American industrialists began to seek better ways to make coke and to capture the chemicals necessary for manufacturing explosives and other synthetic materials. However, the severe air pollution associated with beehive coke ovens continued into the second half of the 20th century. Source: Hamilton A. Exploring the Dangerous Trades, the Autobiography of Alice Hamilton, M.D. Boston: Little, Brown and Co; 1943. Photograph: Reprinted with permission from Gates JK. The Beehive Coke Years: A Pictorial History of Those Times. Uniontown, Pa: John K. Gates; 1990. 4 Occupational Health in the U.S. Army, 1775–1990 Dr. Hamilton identified 2,432 instances of occupa- personal cleanliness, including showers at the work- tional poisoning. Oxides of nitrogen accounted for site and washable work clothing, to reduce the poten- 1,389 cases, and 28 of 53 deaths. TNT exposure was tial for skin contact and accidental ingestion.