"On the Dump Heap": Employee Medical Screening in the Tri-State Zinc-Lead Industry, 19241932
Author(s): Alan Derickson
Source: The Business History Review, Vol. 62, No. 4, (Winter, 1988), pp. 656-677
Published by: The President and Fellows of Harvard College
Stable URL: http://www.jstor.org/stable/3115621
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"On the Dump Heap":Employee Medical
Screening in the Tri-StateZinc-Lead
Industry,1924-1932
ALAN DERICKSON
? In the following article, Professor Derickson examines the motivation for
and the results of employee medical screening of workers in a midwestern
mining community. He argues that, contrary to the goals of the associative
state as envisionedby HerbertHooverand others,governmentand mine operator efforts to determine the extent of respiratory disease among mine workers in the Tri-Statewere neither impelled by a concernfor workers'welfare
nor conducive to the amelioration of their problems.
In January 1917, the U.S. Bureau of Mines (BOM) informed the
Anaconda Copper Mining Company of the disturbing preliminary findings of its study of the health status of miners in Butte, Montana. The
bureau had determined that over two-thirdsof those examined had signs
of either silicosis, a debilitating respiratory disease caused by inhalation of rock dust, or tuberculosis, or both. Anacondavice-president Cornelius E Kelley responded with a proposal that Butte's mine operators
join the investigation as silent partners. In particular, Kelley indicated
that his company "would like to be furnished with a copy of the report
upon each case."l BOM director Van H. Manning had no difficulty in
discerning the practical meaning of this proposition. "I see no objection to your being furnished confidentially with a copy of the report,"
Manning told Kelley on 24 March 1917, "provided that it is agreed that
you take no action to the disadvantage of the miner, such as his discharge upon the basis of the report."Anaconda promptly withdrew its
plan for a joint study of the silicosis epidemic.2
Within a few years, federal occupational health policy became more
accommodating to employers interested in weeding out disabled
employees. Unlike their predecessors in Woodrow Wilson's administration, BOM leaders under presidents Calvin Coolidge and Herbert
Hoover did not hesitate to collaborate with mine operators in examinALAN DERICKSONis assistant professor of history at PennsylvaniaState University.
I thank David Brody and Ron Filippelli for helpful criticism and the Pew MemorialTrustfor generous
financial support.
' C. F Kelley to Van H. Manning,19 March 1917;D. Harringtonto Mr. [George S.] Rice, 16 Feb. 1917,
both Bureauof Mines Records,RG 70, General Records, 1910-50, box 290, file 59203, National Archives,
WashingtonNational Records Center, Suitland, Md.
2
Manningto Kelley,24 March 1917;Kelley to Manning,29 March 1917,ibid.
BusinessHistoryReview62 (Winter 1988): 656-677. ? 1988 by The President and Fellows of Harvard
College.
DERICKSON: MEDICAL SCREENING
657
ing and discharging en masse the victims of silicosis and other workinduced conditions. Between 1924 and 1932, physicians on the public
payroll served essentially as company doctors in administering a diagnostic clinic for the Tri-State Zinc and Lead Ore Producers' Association (OPA) in Picher, Oklahoma.
The Picher clinic embodied a number of the distinctive characteristics of what Ellis W. Hawley called the "associativestate."As envisioned
by its leading advocate, Herbert Hoover, the associative regime would
consist of a system of private government in which trade associations,
professional societies, and other voluntary institutions initiated social
reform and stabilized economic development. Asserting that price-fixing
by a small minorityhad created unwarrantedsuspicion of all trade association endeavors, Hoover pointed to a wide variety of constructive activities undertaken by these bodies. In particular,he praised their growing
interest in the elimination of wasteful practices, broadly defined. As
secretary of commerce, Hoover used his annual report for 1924 to catalogue valuable associational efforts to this end, including the "[plromotion of the welfare of employees, by the improvement of working conditions, sanitation, safety appliances, accident prevention, housing
conditions, and matters of like character."3
From this perspective, the objective of the federal government was
to encourage private initiative in resolving the social and economic
problems of industrialism. The Department of Commerce both energetically publicized and otherwise promoted the promise and accomplishments of associationalism and engaged in diverse cooperative programs to reduce waste in industry. The associative state aimed to serve,
as Hawley put it, "as midwife to a new, non-statist commonwealth."4
THE BUREAU OF MINES
Transferredin 1925 from the Department of the Interior to Hoover's
department, the Bureau of Mines adhered closely to corporatist policy.
Whereas during the previous decade it had entered into formal cooperative arrangements almost exclusively with state mining agencies and
state universities, during the 1920s the bureau increasingly entered partnerships with private parties. Cooperative research projects became
3U.S. Departmentof Commerce, TwelfthAnnualReportof the Secretary,1924 (Washington,D.C., 1924),
23 (quotation), 22-24; Herbert C. Hoover, The Memoirsof lIerbertIloover,vol. 2: The Cabinetand the
Presidency,1920-1933 (New York,1952), 169-70; Joan Hoff Wilson, lherbertlIoover:ForgottenProgressive
(Boston, 1975), 98-101; Robert F. Himmelberg, The Originsof the NationalRecoveryAdministration:Business, Government,and the TradeAssociationIssue, 1921-1933 (New York,1976), 10-11.
4 Ellis W. Hawley,"Herbert Hoover,the Commerce Secretariat,and the Vision of an 'AssociativeState,'
1921-1928,"Journalof American lIistory61 (June 1974):119(quotation),116-40; Hawley,"Three Facets of
HooverianAssociationalism:
Lumber,Aviation,and Movies,1921-1930"'in Regulationin Perspective:
Ilistorical
Essays, ed. Thomas K. McCraw(Cambridge,Mass., 1981),95-123; U.S. Department of Commerce, Trade
AssociationActivities,by IrvingS. Paull,J. W.Millard,and JamesS. Taylor(Washington,D.C., 1927), 126-28,
132, and passim;Louis Galambos,Competitionand Cooperation:TheEmergenceof a NationalTradeAssociation (Baltimore,Md., 1966), 67, 74-75, 93-94, 142-57, 169.
658
BUSINESS HISTORY REVIEW
commonplace. Although most of these investigations took up technological and economic problems, a number addressed health and safety
matters. Under an agreement with the American Petroleum Institute,
the Bureau of Mines, together with the U.S. Public Health Service,
studied the toxic gas hydrogen sulphide, given off by oil refineries, and
proposed corrective action. The BOM joined with the National Coal
Association in the mid-1920s to investigate the problem of roof caveins. In 1926 the bureau and the American Mining Congress developed
and promulgated a safety code for the use of electrical equipment in
coal mines.5
In addition, the BOM under the Warren Harding, Coolidge, and
Hoover administrations frequently joined with trade groups to disseminate health and safety informationand to conduct trainingprograms.
It worked with the bituminous coal operators' national organization to
teach miners first aid and mine rescue methods. BOM director Scott
Turner reported in 1930 that "many of the field men assisted the Portland Cement Association in its no-lost-time-accident drive by giving the
bureau's first aid course to several thousand employees." The agency
also divided educational chores with the National Safety Council and
other private organizations involved in preventing workplace injuries
and illnesses. Thus, the Picher medical screening project fit within a
broad pattern of federal collaborationwith trade and professionalgroups
in the mining sector on various facets of the occupational safety and
health issue.6
In all its health and safety activities,the bureau was confined to providing scientific and technical assistance. Director H. Foster Bain in 1921
emphasized the limitations of federal intervention and the concomitant
need for joint ventures: "[T]he National Government has a part to play,
but only a part, in the work of increasing safety and decreasing waste
in mines and works. It is not too much to say that such success as has
been achieved ... has flowed from the widespread and generous cooperation that has been effected." Of course, a circumscribed role reflected
not merely an ideological commitment to minimal government involve5 William Graebner,Coal-MiningSafetyin the ProgressivePeriod:ThePoliticalEconomyof Reform(Lexington, Ky.,1976),64; BOM,Investigationsof ToxicGasesfromMexicanand OtherIligh-SulphurPetroleums
and Products, by R. R. Sayers, et al., Bulletin 231 (Washington, D.C., 1925); BOM, Safety Rulesfor Installing
and UsingElectricalEquipmentin CoalMines,Sponsoredby U.S.Bureauof Minesand AmericanMiningCongress, Technical Paper 402 (Washington, D.C., 1926); BOM, Sixteenth Annual Report of the Director . . for
the Fiscal YearEndedJune 30, 1926 (Washington,D.C., 1926), 11-12;BOM, AnnualReportof the Director
... for the Fiscal Year Ended June 30, 1931 (Washington, D.C., 1931), 41-42, 51; Harry L. Candy [Executive
Secretary, National Coal Association], "Keeping Everlastingly at It," in National Safety Council, Transactions of the Sixteenth Annual Safety Congress, 1927 (N.p., 1928), 2: 209; U.S. Department of Commerce, Trade
AssociationActivities,320.
6 BOM,AnnualReportof the Director... for the FiscalYearEndedJune30, 1930 (Washington,D.C., 1930),
60; BOM, The Spring Canyon Mine Rescue Association, by A. L. Murray, Report of Investigation 2361 ([Washington, D.C.], 1922), 1; BOM, The Sand and Gravel Safety Contest of 1929, by W. W. Adams, Report of Investigation 3009 ([Washington, D.C.], 1930), 1 and passim; BOM, Bureau of Mines Instruction in First Aid, by A.
L. Murray, Information Circular 6217 ([Washington, D.C.], 1930), 17-18; Candy, "Keeping Everlastingly at
It," 2: 209; Mining Congress Journal, April 1921, 145, 146, Oct. 1925, 477.
DERICKSON: MEDICAL SCREENING
659
ment, but also the constraintsof a federalismthat gave the states primary
responsibility for regulating working conditions. In addition, it reflected
the meager budget and staffresources that foreclosed much BOM initiative.7
Lacking coercive power over mine operators, the agency appealed
strongly to enlightened self-interest. At the 1922 meeting of the American Institute of Mining and Metallurgical Engineers, for example, BOM
engineer Daniel Harrington justified recent work on controlling dust
and humidity primarilyin pragmaticterms. "The general idea is to attack
this question first from the viewpoint of health," explained Harrington,
"follow that with the influence of that health and comfort on efficiency,
and later translate these results into dollars and cents. The dollars-andcents viewpoint is, probably, the most important in the long run...."8
Twoyears later,T. T. Read, Safety Service Director of the agency,assured
the American Mining Congress that "[t]he very complete records of the
United States Steel Corporation indicate that ... the economic saving
from [accident] reduction greatly exceeds the cost of safety precautions."
In the same vein, the bureau's chief surgeon, R. R. Sayers, contended
that employee medical examinations were simply good business practice. Sayers observed in 1923 that "[m]ine operators and managers for
a number of years have known that the maintenance of health among
the workers has an appreciable financial value."9
At the same time that it actively encouraged mine operators to
ameliorate working conditions, the BOM maintained only the most
minimal relationship with organized labor. Some historians have made
too much of Hoover's brief, half-hearted flirtation with Samuel Gompers.'0 In the early 1920s, the U.S. labor movement lost one strike after
another and almost a third of its membership. The International Union
of Mine, Mill and Smelter Workers,the AFL affiliate whose jurisdiction
included zinc and lead miners, virtuallydisappearedin the postwaryears.
7 H. Foster Bain, "The Bureauof Mines and Private
Investigations,"Engineeringand MiningJournal, 17
Sept. 1921,450 (quotation),450-51; Fred W. Powell, TheBureauof Mines:Its Ilistory, Activitiesand Organization (New York,1921), 7, 21; BOM, Annual Report,Fiscal 1931, 51.
8 Daniel Harrington,"Comment"on CharlesA. Mitke,"Metal-MineVentilationin the Southwest,"Transactions of the AmericanInstituteof Miningand MetallurgicalEngineers68 (1923):404; Daniel Harrington,
"Efficient Ventilationof Metal Mines,"ibid., 407-8, 413-14.
9 T.T. Read,"Some Problemsof Mine
Safety,"MiningCongressJournal,Oct. 1924, 474; BOM,Morbidity
Studiesas an Aid in PreventingIllnessamongMiners,by R. R. Sayers,Reportof Investigation2453 ([Washing-
ton, D.C.], 1923), 1; BOM, The Cost of Accidents to Industry, by F. S. Crawford, Information Circular 6333
([Washington,D.C.], 1930).
10Cf. William A. Williams, TheContours American
of
Iistory (Cleveland,Ohio, 1961),427-32; Stephen
J. Scheinberg, Employersand Reformers:The Developmentof CorporationLabor Policy, 1900-1940 (New
York,1986), 198-213; RonaldRadosh,"Laborand the AmericanEconomy:The 1922 RailroadShop Crafts
Strike and the 'B&O Plan,' " in Building the OrganizationalSociety:Essays on AssociationalActivitiesin
Modern America, ed. Jerry Israel (New York, 1972), 73-87. For a more accurate assessment of Hoover's limited
interest in bringing organized labor into corporatist arrangements, see Robert H. Zieger, "Labor, Progressivism, and Herbert Hoover in the 1920s," Wisconsin Magazine of listory 58 (Spring 1975): 196-208; Zieger,
"Herbert Hoover, the Wage-earner, and the 'New Economic System, 1919-1929," Business IIistory Review
51 (Summer 1977): 161-89; and Haggai Hurvitz, "The Meaning of Industrial Conflict in Some Ideologies
of the Early 1920s" (Ph.D. diss., Columbia University, 1971), 242-44, 252-60.
BUSINESS HISTORY REVIEW
660
The "fall of the house of labor" meant that Hoover and other architects
of public policy could ignore weak unions or, as in the Tri-State zinclead industry,could operate with no unions at all to take into account.1
CONDITIONS
AT THE PICHER
MINES
Following its discovery around 1915,the Picher field quickly became
the leading producer of zinc ore in the world, as well as an important
source of lead ore. From this thousand-square-milearea of northeastern
Oklahoma, southeastern Kansas, and southwestern Missouri, miners
extracted, on average, roughly 30 percent of U.S. zinc production during the early 1920s. Shallow, diffusely distributed ore deposits permitted the operation of many small firms with little capital. With 159 firms
active in 1920, the Tri-Statedistrict enjoyed a reputationas a "poor man's
camp." But Charles Morris Mills, an agent of the Interchurch World
Movement who visited the area that year, noted
a distinct tendency toward a semblance of centralization. There has been a large
increase in the acreage and holdings of large companies. The number of employes
in these larger companies has also increased. A few years ago, an operating company employing 50 to 100 men was regarded as a large company. Todayone company employs over 1,200, and several between 250 and 500. In other words, the
Joplin area is gradually, though not altogether distinctly, growing into a state of
industrialism.... 12
Nonetheless, the promise of relatively high wages and the lingering possibility of eventually running one's own mine attracted a steady supply
of farmers and their sons from surrounding rural areas, especially the
nearby Ozarks. In 1923, over 4,500 men worked underground in the
Tri-State.'3
Unplanned communities sprang up amid the mines. By one account,
Picher in its early days resembled an "old time Western boom mining
town with flimsily constructed buildings, and almost total disregard of
such civic adjuncts as sewers, sanitary water supply or other sanitation
or public health facilities"14Mine tailings, piled up to one hundred feet
high, covered thousands of acres. The "Sahara-likepanorama"of these
" Leo Wolman,Ebb and Flow in TradeUnionism(New York,1936), 173, 193; David Montgomery,The
the State,and LaborActivism,1865-1925(New York,1987),397-457;
Fallof theIlouseof Labor:TheWorkplace,
VernonH. Jensen, Ileritageof Conflict:LaborRelationsin the NonferrousMetalsIndustryup to 1930 (Ithaca,
N.Y.,1950), 452-66.
12 Charles MorrisMills,
"JoplinZinc: IndustrialConditions in the World'sGreatest Zinc Center,"Survey, 5 Feb. 1921,659 (quotation),658-60, 663; BOM, SummarizedStatisticsof Productionof Lead and Zinc
in the Tri-State(Missouri-Kansas-Oklahoma)
MiningDistrict, by A. J. Martin,InformationCircular 7383
([Washington,D.C.], 1946), 10-11, 15; Arrell M. Gibson, WildernessBonanza:The Tri-StateDistrict of Missouri, Kansas,Oklahoma(Norman, Okla., 1972), 79-80, 170-71.
13Mills,"JoplinZinc"'658; WilliamJ. Cassidy,"TheTri-StateZinc Lead MiningRegion:Growth,Problems,
and Prospects" (Ph.D. diss., Universityof Pittsburgh, 1955), 242.
"4Daniel Harrington,et al., "Dust-VentilationInvestigationin the Mines of the Picher, OklahomaDistrict,"Dec. 1923, 6 (quotation),30-31, BOM Records,RG 70, Health and Safety Branch, Records of the
Picher, Oklahoma,Clinic, 1927-1932, [hereaftercited as Picher Clinic Records],box 2, file 082.
DERICKSON: MEDICAL SCREENING
661
TAILING PILES FROM ZINC ORE PROCESSING
Zinc ore mills discarded millions of tons of mineral waste. Dump heaps covered much of
Picher,Oklahoma,and other communitiesin the Tri-Statedistrict. (ReproducedfromSurvey,
5 Feb. 1921, 657.)
industrial badlands disturbed Charles Mills. "Everything has been
sacrificed," he lamented, "in the feverish scramble to get as much ore
out in the quickest time possible."15
Piece-rate pay kept workers scrambling, and many of them sacrificed
their health in the process of gaining their wages. Falling rock, faulty
hoisting equipment, dynamite,unguardedmachinery,and a host of other
hazards caused innumerable accidents underground. More important,
payment by output drove ore shovelers to exacerbate the preexisting
silica dust hazard. Hand loading between twenty and fifty tons of ore
per eight-hour day stirred up a great deal of toxic dust. In addition,
strenuous exertion made workersbreathe hard and fast, increasing their
dose of microscopic rock particles. "In comparison," Mills concluded,
"a twelve- and fourteen-hour day on the open hearth in the steel industry seems comfortable."16
Industrial respiratory disease caused growing concern among mine
managers. Most undoubtedly knew that federal investigatorshad found
widespread "miners' consumption" in nearby Joplin, Missouri, in
1914-15. Most operators also probably preferred an inquiry by a federal
15Mills, "JoplinZinc,"657.
(quotation),660-62; Harrington,et al., "Dust-VentilationInvestigation,"15-30; P. R. Coldren, "Joplin-MiamiDistrict,"Engineeringand MiningJournal, 26 Nov. 1921, 871.
16 Ibid., 661
662
BUSINESS HISTORY REVIEW
agency lacking police powers to an investigation by state officials who
were more likely to propose protective legislation that they themselves
would administer. Accordingly, Tri-State operators in 1922 asked the
BOM to examine their employees and the conditions under which they
worked and to propose corrective action. The bureau sent a team headed
by veteran mining engineer Daniel Harrington to investigate.17
Harrington and colleague Richard V. Ageton visited forty-six mines
around Picher during 1923. They encountered a significant dust threat
to all underground workers. In addition to the practice of shoveling ore
dry, many other procedures led to the thorough contamination of the
working environment. Dry drilling of the holes into which explosives
were placed created clouds of silica particles. In some mines, blasting
occurred while employees were still underground. Moreover, Harrington and Ageton observed,
Even when blasting is done when going off shift, the very heavy nature of the
blasting in these mines throws into the air large numbers of very fine dusts and
the large volumes of open underground spaces ... allow these very fine, very dangerous particles to remain in suspension for hours, even for days, unless moved
by ventilating currents.'8
Operatorsseldom invested in adequate ventilation equipment. For thirty
environmental samples taken in diverse work sites, silica dust averaged
4.2 milligrams per cubic meter of air, a level of pollution that exceeds
the 1988 federal standardfor silica exposure in undergroundmetal mines
by at least ten times.19
Not surprisingly,this hazardhad serious health consequences. Despite
the long latency period between initial exposure to silica particles and
the onset of disease symptoms-usually ten years or more-a substantial number of Tri-State miners already displayed signs of silicosis by
1923, less than a decade after mining operations began. Dr. Frederick
Flynn found manifestations of simple silicosis or silicotuberculosissilicosis complicated by tuberculosis-among 208 of 309 workers. In
addition, the federal consultants suggested that "much of the high accident rate at and near the working face is due to the fact that many of
these men have to some extent silicosis or tuberculosis, or both."20
The BOM insisted that "unless definite drastic remedial measures
are adopted, the disease condition will grow rapidly worse."21Harrington and his co-workers proposed a public educational campaign on the
nature, causes, and prevention of silicosis. They also recommended
17
BOM, SiliceousDust in Relationto PulmonaryDisease amongMinersin the Joplin District, Missouri,
by Edwin Higgins, et al., Bulletin 132 (Washington,D.C., 1917);Alan Derickson, "FederalInterventionin
the Joplin Silicosis Epidemic, 1911-1916,"
Bulletinof the Ilistory of Medicine62 (Summer 1988): 236-51;
Harrington,et al., "Dust-VentilationInvestigation,'4, 15.
18Harrington,et al., "Dust-VentilationInvestigation:'21.
19Ibid., 8-28.
20 Ibid., 28
21 Ibid., 30.
(quotation),29-30.
DERICKSON: MEDICAL SCREENING
663
ZINC MINERS ABOUT TO DESCEND
Oklahoma law required that mine workers be protected by a safety cage, but most underground employees had to ride in an ore bucket instead. Despite the relative shallowness
of the Tri-Stateworkings-less than 300feet-this practice led to numerous serious injuries. (Reproducedfrom Survey, 5 Feb. 1921, 659.)
administrative and engineering changes to prevent disease. These
included more systematic use of wet methods in drilling and handling
rock, prohibition of all blasting on shift, and installation of modern ventilation apparatus. Many firms, especially the larger ones, tried to follow these guidelines.22
22 Ibid., 32
(quotation),36-38; [OPA],"Analysisof Mine Safety Rules Presented to JudgingCommittee
of American Mining Congress, Tri-StateDistrict," 1 Aug. 1924, Picher Clinic Records,box 1, file 022.
664
BUSINESS HISTORY REVIEW
THE USES OF MEDICAL SCREENING
Complete abatement of the epidemic entailed more than eradicating its causes. The operators also had to eliminate advanced silicotics
from the work force. Medical screening, followed by termination of those
found to have the disease, was one common method of achieving this
objective. The system of medical examinations developed during the
preceding decade in South Africa strongly influenced U.S. mining officials. In 1921 Sayers called attention to "the regular periodic physical
examination of the underground employees, resulting in the elimination of those affected with silicosis," in the Transvaalgold mines.23The
federal authorities urged that "all mines of the Picher district have
employees examined physically at least once every six months,"the frequency with which native laborers were screened in the Transvaal.24
Such periodic examinations, together with pre-employment screening of job applicants, were the primary component, if not the raison
d'etre, of most medical programs administered by U.S. employers in the
early twentieth century. Hundreds of industrial establishments set up
medical departments in response to the enactment of workers' compensation legislation in the 1910s.These programssurvivedthe cutbacks
in personnel management brought on by the postwar depression and
became well entrenched in the 1920s in large part because physical
evaluations helped identify the least efficient workers for layoff.25
A small firm usually could not afford to retain its own medical staff.
Hence, the BOM encouraged the Ore Producers'Associationto organize
"a department of true industrial medicine" to serve its members.26
Apparently, even this proposition was beyond the means of the zinclead companies. Instead, the federal bureau, which had a corps of physicians, agreed to a joint undertaking with the trade association, which
brought together most of the operators in the district. With the aid of
the Picher post of the American Legion, the Ore Producers' Association and the Bureau of Mines in 1924 opened a modest diagnostic facil23BOM,Preventionof IllnessamongMiners,by R. R. Sayers,Reportof Investigation2319 ([Washington,
D.C.], 1922), 7; BOM,SilicosisamongMiners,by R. R. Sayers,TechnicalPaper372 (Washington,D.C., 1925),
20-23; R. R. Sayersand A. J. Lanza, "Historyof Silicosis and Asbestosis,"in Silicosis and Asbestosis,ed.
A. J. Lanza (New York,1938), 6-7; Union of South Africa, Department of Mines and Industries, Miners'
PhthisisBoardand Miners'PhthisisMedicalBureau,InterimReportsforthe Period1 Augustto 31 December
1916(Cape Town,1917);Alan Derickson, "IndustrialRefugees:The Migrationof Silicotics from the Mines
of North Americaand SouthAfricain the EarlyTwentiethCentury,"LaborIistory 29 (Winter1988):85-87.
24Harrington,et al., "Dust-VentilationInvestigation,"34.
25 "Foreword,"iii; William A. Sawyer[EastmanKodak],"The Medical Department in Industry,"18-19;
C. H. Watson[AmericanTelephone& Telegraph],"PhysicalExaminations:A Resume,"22-26, all in National
IndustrialConference Board,ed., The Physicianin Industry:A Symposium,Special Report22 (New York,
1922);NationalIndustrialConference Board,MedicalCareof IndustrialWorkers(New York,1926), 25-38,
65-69; U.S. Public Health Service, Studiesof the Medicaland SurgicalCare of Industrial Workers,by C.
D. Selby, Bulletin 99 (Washington,D.C., 1919),passim; Angela Nugent, "Fit for Work:The Introduction
of Physical Examinationsin Industry,"Bulletin of the Historyof Medicine57 (Winter 1983): 578-95.
26Harrington,et al., "Dust-VentilationInvestigation,"34; NationalIndustrialConference Board,Industrial RelationsProgramsin Small Plants (New York,1929), 26.
DERICKSON:MEDICALSCREENING 665
ity staffed by one doctor. During the year ending 1 October 1926, Dr.
E. E. Nunnery examined 939 men at the Silicosis Tuberculosis Clinic.27
In addition to its cosponsorship of the screening center, the OPAhired
Richard Ageton from the BOM to direct a campaign to prevent mine
accidents and control the silica threat. The operators' organization also
developed a private welfare system of disability insurance and nursing
services.28 The OPA thus assumed, in some respects, the progressive
role that Hoover and enlightened corporate leaders envisioned for voluntary institutions. An integral part of benevolent welfare capitalism, the
diagnostic clinic set out to serve both employer and employee.
In addition, the association represented the narrower economic
interests of the companies in the district. Like its predecessors since
the turn of the century, the OPAprimarilyaimed to maintainhigh prices
for zinc concentrates. To that end, it lobbied for tariffs and gathered
production and consumption data. It also fixed wages and kept watch
for union sympathizers.29
The OPA could not, however, impose stability on the zinc industry.
Although its members produced a substantial proportion of the nation's
zinc ore, the association covered only one of several centers of production in the United States. Moreover, a "poor man's camp" of small
producers was the very antithesis of an oligopoly under which a handful of firms could agree to restrain output and hold prices. Too many
small operators had to sell their ore, regardless of price. When demand
soared in the early 1920s, all went well. Tri-Statezinc production grew
from 169,211 tons in 1921 to 423,800 in 1926, a level of output employing over 9,000 workers. Then demand plunged. As in coal, textiles, and
other industries plagued by overproduction, the depression in zinc long
preceded the Crash of 1929. Tri-Stateoutput in 1927 amounted to only
330,530 tons. Operators throughout the district began to lay off
employees. Unencumbered by union rules, managerspreparedto dispose
of a substantial share of their workers.30
Winnowing the work force overtaxed the meager facilities of the Silicosis TuberculosisClinic. At the same time, a Canadianpolitical development underscored the need to expand medical services. In 1926, the
27 E. R.
Sayres[sic-R. R. Sayers],E. R. Hayhurst,and A. J. Lanza,"Statusof Silicosis,"AmericanJournal
of PublicIlealth 19 (June 1929):637; BOM, Silicosisand TuberculosisamongMinersof the Tri-StateDistrict
of Oklahoma,Kansasand Missouri-I, by R. R. Sayers,F V. Meriwether,A. J. Lanza, and W. W. Adams,
TechnicalPaper545 (Washington,D.C., 1933), 2; RichardV.Agetonto J. D. Conover,12 Oct. 1926, Tri-State
Zinc and Lead Ore ProducersAssociationRecords(Picher MiningMuseum,Picher,Okla.) [hereaftercited
as OPA Records],envelope: "AnnualMeetings of Association:' folder: "AnnualMeeting, 1926."
28 [OPA],"Analysisof Mine Safety Rules"; BOM, Silicosis and Tuberculosis-I, 30.
29James D. Norris, "The Missouriand KansasZinc Miners'Association, 1899-1905,"BusinessIlistory
Review40 (Autumn1966):321-34; Engineeringand MiningJournal,11March1922, 419;OPA,Constitution
and By-Laws, 1923 (Miami, Okla., 1923); Harrington,et al., "Dust-VentilationInvestigation', 6; Cassidy,
"Tri-StateRegion,"257-59.
30BOM, Productionin Tri-State,15; Cassidy,"Tri-StateRegion:' 241-42; M. D. Harbaugh,"LaborRelations in the Tri-StateMining District,"MiningCongressJournal,June 1936, 21; Irving Bernstein, The Lean
Years:A Ilistory of the American Worker,1920-1933 ([1960];Baltimore,Md., 1966), 3-4, 127-28.
666 BUSINESSHISTORYREVIEW
province of Ontario, an important metal mining center, substantially
broadened coverage of miners' silicosis under its Workmen'sCompensation Act.31If mandatory compensation for silicosis-by 1927 the law
in South Africa and England, as well as in Ontario-were unavoidable,
then it was only prudent to take preemptive action to limit the number
of claimants for benefits.32
But the enactment of social insurance for silicosis was by no means
a foregone conclusion in the Tri-State,or anywhere in the United States,
in the 1920s. The wave of compensation laws passed in the 1910sgenerally covered only traumaticinjuries and excluded work-induceddiseases.
Among the major metal-mining states, only California compensated
employees who incurred occupational illnesses. Since 1913 the International Union of Mine, Mill and Smelter Workers and its predecessor,
the Western Federation of Miners, had led the fight for the extension
of workers' compensation to cover silicosis and a variety of other disorders but, despite repeated organizing campaigns, the union had not
one local functioning in the Tri-Statein the 1920s. Whereas the federal
officials involved in the Joplin study of 1914-15 had openly supported
the enactment of occupational disease compensation, after 1920 the
BOM fell silent on the issue. Hence, with the Mine, Mill and Smelter
Workers in disarray and the Bureau of Mines unwilling to advocate
expanded legislation, it must have appeared to Tri-State operators in
the mid-1920s that they had an opportunity to take care of the silicosis
problem without provokingagitation for compensation reform. In these
circumstances, the implementation of elaborate private medical and
hazard-controlprogramsmight serve to defuse demands for social insurance legislation.33
Whereas disabled miners in Ontario replaced a fraction of lost earnings through social insurance, their counterparts in Kansas, Oklahoma,
and Missourirelied on privategroup disabilityand life insurancebenefits.
The operator paid the premiums for workers' life insurance coverage,
but the employees financed disability insurance-so-called sickness and
31 Ontario,Statutes,1926
(Toronto,1926), 375-76; Daniel Harrington,"Reportof Committee on Metal
Mine Ventilation," in Transactions of the American Institute of Mining and Metallurgical Engineers 75 (1927):
143-44.
32 British
policymakerschose not to include silicosis on the initial schedule of compensable diseases
because they feared wholesale firings of silica-exposedworkers. See Thomas Legge, IndustrialMaladies
(London,1934), 21. SouthAfricanmine ownersdischargedsuspected silicotics when passageof the Miners'
PhthisisActof 1912became imminent.See Engineeringand MiningJournal,1 June 1912,1102.When Illinois
enacted silicosis compensationin 1936,one factoryowner reportedlyterminated180 employeesjust before
the effective date of the law. See Albert T. Helbing, "OccupationalDisease Legislation in Illinois', Social
Service Review 12 (March 1938): 119.
33U.S. Bureau of Labor Statistics, Workmen's Compensation Legislation of the United States and Canada,
by LindleyD. Clarkand MartinC. Frincke,Jr.,Bulletin 272 (Washington,D.C., 1921),308 and passim;Alan
Derickson, Workers'Iealth, Workers'Democracy: The Western Miners' Struggle, 1891-1925 (Ithaca, N.Y., 1988),
180-82; Gibson, Wilderness Bonanza, 229; BOM, Pulmonary Disease among Miners in the Joplin District,
Missouri, and Its Relation to Rock Dust in the Mines: A Preliminary Report, by A. J. Lanza and Edwin Higgins, Technical Paper 105 (Washington, D.C., 1915), 44; BOM, Development of Workmen's Compensation Insur-
ancefor MetalMines,by ByronO. Pickard,Reportof Investigation2590 ([Washington,D.C.], 1924), passim.
DERICKSON:MEDICALSCREENING 667
accident insurance-through payroll deductions. The Metropolitan Life
Insurance Company was the largest underwriter of this disability coverage, both in the United States as a whole and in the Tri-State.Workers
could properly obtain benefits only for nonoccupational illnesses and
injuries. But in reality, because many advanced silicotics also acquired
tuberculosis, it was often impossible to separate work-related disorders
from those unrelated to work.34
Faced with the prospect of an avalanche of respiratorydisease claims,
Metropolitan attempted to contain its costs. Like the OPA, it sent visiting nurses to care for and educate sick miners. The giant insurance carrier also helped group policyholders control dust. In fact, Dr. Anthony
J. Lanza, head of Metropolitan'sIndustrial Health and Hygiene Service,
had led the Joplin study a decade earlier while he was in the federal
service. In 1927 Metropolitan joined the BOM and the OPA in a more
systematic campaign to curtail the silicosis outbreak.3
The three organizations entered into a formal agreement to maintain
a clinic whose purpose was to diagnose silicosis and tuberculosis. Under
this arrangement, the BOM and Metropolitan each were to contribute
$8,000 per year to the project; the OPA was obligated to raise $16,000
among its member firms. The partners purchased, renovated, and
equipped a new, larger diagnostic facility in Picher. The U.S. Bureau
of Mines Cooperative Clinic opened in the spring of 1927, under the
direction of Dr. E V. Meriwether. A staff of four doctors assessed the
health status of current and prospective mine workers.Like Meriwether,
these physicians were employees of the U.S. Public Health Service on
assignment to the BOM.36
The clinic began with the onerous task of examining all active
employees of the companies that supported it, as well as evaluatingapplicants for work. In September 1927, for example, the institution conducted 1,604 such examinations. These initial evaluations were quite
comprehensive. Clinic stafftook a detailed history of each patient, eliciting information on the extent of occupational exposure to rock dust.
Each worker then underwent a thorough physical examination, a chest
X-ray, and a series of laboratory tests.37
34Louis I. Dublin, A
Familyof ThirtyMillion:TheStoryof the MetropolitanLife InsuranceCompany(New
York,1943), 167-206; R. A. Stengel to F. V.Meriwether,11Jan. 1930, Picher Clinic Records,box 1, file 021;
John W. Campbelland E. C. Mabon,"Personneland Safety,"Engineeringand MiningJournal,Nov.1943, 120.
35Dublin, Family
of ThirtyMillion,176-77, 425, 433; RichardJenkins,"Reportof WelfareDepartment,
YearEndingSeptember30, 1930,"OPARecords,envelope:"AnnualMeetingsof Association:'folder:"Annual
Meeting-October 22, 1930";R. R. Sayersto L. R. Thompson, 16 March1933, NationalInstitute of Health
Records,RG 443, RecordsRelatingto NIH Divisions, 1930-48, box 182, folder: "Div[ision of] Ind[ustrial]
Hyg[iene],1932-1936,"NationalArchives;BOM, Silicosisand Tuberculosis-I,2; Departmentof Commerce
and Tri-StateZinc and Lead Ore Producers Association,"CooperativeAgreement,"24 June 1927, Picher
Clinic Records,box 1, file 022.
36BOM,Silicosisand Tuberculosis-I,2; RichardV.
Agetonto ArthurL. Murray,9 April1927,OPARecords,
unnamedbox, folder:"United States Departmentof Commerce (Bureauof Mines)Misc.Correspondence";
Department of Commerce and OPA, "CooperativeAgreement."
37F. V. Meriwetherto R. R.
Sayers,4 Oct. 1927, Picher Clinic Records,box 5, file 094; BOM, Silicosis
668
BUSINESS HISTORY REVIEW
Meriwether and his staffpossessed both the technology and the expertise to identify silicosis. The etiology, signs, and symptoms of this disorder were well defined by 1927. Beginning in the late nineteenth century, the publication of numerous case reports and epidemiological
surveys had shown the medical profession not only the clinical picture
of silicosis but its widespread prevalence as well. Similarly, workers,
managers, and the general public in metal-mining districts throughout
North America had become aware of diverse manifestations of the silicosis epidemic by the 1920s.38
Physiciansat the Picher clinic differentiatedsilicosis cases by severity.
The staging scheme they used derived directly from Lanza's work in
Joplin. It divided the downwardtrajectoryof the disease into three stages
by positivistic criteria:
The first stage means that definite physical signs of damage to the lungs have been
found and that such damage has resulted from exposure to dust. The second stage
means that definite and specific physical signs of silicosis are or have been present
and that capacity for work has been impaired by the disease, though not seriously. The third stage means that the capacity for work has been seriously and
permanently impaired by the disease.39
Observable signs of damage, not subjective reports of pain or discomfort, indicated silicosis.
The classificatory plan narrowed the conceptualization of silicosis in
another way.To a substantialextent, this staging system defined occupational disease in terms of occupational disability:a workerwas sick when
his capacity for work diminished. This criterion undoubtedly made distinctions that were useful for employers in maximizing productivity.But
this limited standard ignored all aspects of a miner's life except one.
(Consider the alternative criteria of classifying the severity of disease
in terms of the capacity to play with one's children or to walk to church.)
The BOM staging system, like antebellum southern physicians' definitions of slave diseases and male physicians' analysis of women's health
problems, denied human complexity40The clinical context-a hurried,
and Tuberculosis-I,4; Bureauof MinesClinic,"IndividualHistory[Form],'n.d.,OPARecords,box:"Weekly,
Monthlyand YearlyProduction,etc., Reports, 1923-1939;' folder: "Clinic-General, July 1, 1930 to July
1, 1931."
38A. J. Lanza,"Miners'Consumptionin SouthwesternMissouri,"Journalof the MissouriState Medical
Association13 (June 1916):251-54; RobertT. Legge, "Miners'Silicosis:Its Pathology,Symptomatologyand
Prevention:'Journalof the AmericanMedicalAssociation81 (Sept. 1923): 809-10; Henry K. Pancoastand
Eugene P. Pendergrass,"AReviewof Our Present Knowledgeof Pneumoconiosis,Based upon Roentgenoand Radium
logic Studies,with Notes on the Pathologyof the Condition:'AmericanJournalof Roentgenology
Therapy14 (Nov. 1925): 381-410, 414; BOM, Silicosisamong Miners,by R. R. Sayers,TechnicalPaper 372
Workand
Asbestosis,"
of
Silicosis
Derickson,
5-22;
(Washington,D.C., 1925);Sayersand Lanza,"History
ers' lealth, Workers'
Democracy,42-53; MiningCongressJournal,March1915,163-64; Engineeringand Mining
Journal, 11 Dec. 1915,976.
39BOM, Silicosis and Tuberculosis-I, 4 (quotation),26-27; BOM, SiliceousDust in Joplin, 70.
40John S. Haller, "The Negro and the Southern Physician:A Study of Medical and Racial Attitudes,
1800-1860,"MedicalIllstory 16 (July 1972):238-53; CarrollSmith-Rosenbergand Charles E. Rosenberg,
"TheFemaleAnimal:Medicaland BiologicalViewsof Womanand Her Rolein Nineteenth-CenturyAmerica,'
Journal of AmericanIistory 60 (Sept. 1973): 332-56.
DERICKSON:MEDICALSCREENING 669
impersonal screening with no ongoing doctor-patient relationshipfacilitated this sort of reductionism.
The zinc-lead miners had little choice but to adopt the narrow role
prescribed for them. Driven by economic necessity, they literallyworked
themselves to death. Most had migrated from distressed agricultural
areas. The Tri-Statewas an isolated district where few opportunities for
nonmining employment existed. Moreover,many workers had widowed
mothers or disabled fathers to support. Hence, miners did what they
could to conceal signs of the disease during examinations. More important, if silicosis was defined largely by inability to work, then clinging
to a job meant that an individual did not have the disorder. Silicotics
commonly transferred to the less strenuous jobs underground. Some
turned to alcohol and patent medicines to alleviate symptoms and keep
working. Sick miners could not, however, deceive radiologic technology: the distinctive nodules and masses of fibrotic scarring stood out
unmistakably.Chest X-raysenabled the operators to identify silicotics.41
The clinic staff diagnosed a wide range of conditions besides silicosis. In particular,they identified many cases of tuberculosis and venereal
disease. Both disorders diminished their victims' productivity markedly
and predisposed the afflicted to compensable accidents on the job. In
addition, Dr. Meriwether informed OPA secretary Julian Conover in
October 1928, his team of doctors had "examined during the past year
188 men industrially blind in one or both eyes" and reported numerous "other defects that affect the working efficiency of the men to a
more or less decided extent."42
The federal physicians translated their diagnoses into employability
ratings. Miners received photographic identification cards bearing a letter grade. A worker deemed "[p]hysically sound" received an "A"rating. "B" men were "[a]verage,with such minor defects as ... slightly
more fibrosis than normal in lungs."A "C" signified first-stage silicosis
and "other diseases that do not seriously interfere with working efficiency." "D" indicated second-stage silicosis and other disabilities that
"seriously interfere with working capacity." Those "[p]ractically deaf
or blind" or in the third stage of silicosis received an "E" grade. Classifications "F" through "K" covered tuberculosis, with and without
underlying silicosis.43
During its initial year of operation the clinic detected silicosis in a
sizable share of those examined. For the year that ended 30 June 1928,
41BOM,Silicosisand Tuberculosis-I,5, 11-13,16,21, 23-25; BOM,Siicosis and iTberculosisamongMiners
of the Tri-StateDistrict of Oklahoma,Kansasand Missouri-II, for the YearEndedJune 30, 1929, by F V.
Meriwether,R. R. Sayers,and A. J. Lanza,TechnicalPaper552 (Washington,D.C., 1933), 16;TonyMcTeer,
Statement, in U.S. Division of Labor Standards,Conferenceon lHealthand WorkingConditionsin the TriState District, 23 April 1940 (Washington,D.C., n.d. [1940]), 25.
42 F. V. Meriwetherto J. D. Conover,20 Oct. 1928, Picher Clinic Records,box 1, file 022; BOM, Silicosis
and Tuberculosis-II, 1.
43 Sayres,Hayhurst,and Lanza, "Status of Silicosis,"639-40; BOM, Silicosis and Tuberculosis-I, 4.
670
BUSINESS HISTORY REVIEW
MINE WORKER'S NEGATIVE CHEST X-RAY
The staff of the Picher clinic classified as "essentially negative" not only clear lungs but
also those with somefibrosis. (Reproducedfrom U.S.Bureau of Mines, Silicosis and Tuberculosis among Miners of the Tri-State District of Oklahoma, Kansas and Missouri-I,
by R. R. Sayers, F. V. Meriwether, A. J. Lanza, and W W Adams, Technical Paper 545
[Washington, D.C., 1933], following p. 24.)
investigators found that of 7,722 men diagnosed, 1,647 (21.3 percent)
had the disorder, and another 267 (3.5 percent) had silicosis complicated by tuberculosis. Among the 2,159 examinees who had spent more
than ten years in the mines, 939 (43.5 percent) had silicosis and 188
(8.7 percent) had silicotuberculosis.44
The BOM recommended that employees with ratings below "C" be
discharged and that job applicants in those classes be rejected. Based
on the clinic's first year of experience, Meriwether advocated "an ironclad rule that no man be employed until they have a card showing that
their physical condition is C class or better."The clinic director praised
three firms that had already achieved "a marked reduction in cases of
Silicosis" by "paying close attention to the physical examinations."He
estimated that for the district as a whole more than half of the tubercular and advanced silicotic employees-over three hundred men-had
already lost their jobs.45
44BOM, Silicosis and Tuberculosis-I, 14.
45[Meriwether] "AnnualReportfor the Fiscal YearEnding [30 June] 1928 of the US Bureauof Mines
Health Clinic,] Picher,Oklahoma"9 (quotation),6 (quotation),Picher Clinic Records,box 5, file 091;BOM,
Silicosis and Tuberculosis-I, 14.
DERICKSON: MEDICAL SCREENING
671
X-RAYSHOWING THIRD-STAGE SILICOSIS WITH TUBERCULOSIS
In its advanced, complicatedform, miners' respiratory disease appeared radiographically
as sizable areas of "marked density" in the apexes and mid-sections of the lungs. Men in
this stage of deterioration were barred from the mines. (Reproducedfrom U.S. Bureau of
Mines, Silicosis and Tuberculosis among Miners of the Tri-State District of Oklahoma,
Kansas and Missouri-I [Washington, D.C., 1933], following p. 24.)
Federal officials authorized this systematic campaign to deny employment to disabled workers for reasons beyond a desire to maximize
productive efficiency. Meriwether and his colleagues genuinely believed
that advanced silicotics posed an accident risk to themselves and fellow workers. They recognized that advanced silicosis predisposed
strongly to tuberculosis. In turn, they feared that silicotubercular men
would infect their co-workers. Finally, the employability of even firststage silicotics was controversial at this time. Hence, the BOM saw the
removal of the most serious cases as a moderate alternative to a flat prohibition of all those who displayed any evidence of the disorder.46
A hardnosed perspective offset this humanitarianism. Meriwether
assumed that his mandate to increase productivity entailed a broad
responsibility to rationalize personnel policy. Critical of labor turnover
that "increase[d] inefficiency,' he advised the OPA to screen potential
employees more carefully. "Some men employed in the district are disturbers,"he observed. Then the public health expert warned of the threat
46 Meriwether,
"Reportfor Fiscal 1928";D. E. Robertsonto Lanza,7 Feb. 1928; Meriwetherto Lanza,
22 March 1928, both Picher Clinic Records,box 1, file 021.
672
BUSINESS HISTORY REVIEW
of political contagion and described preventive measures. "Such men
not only tend to increase turnover, but create dissatisfaction in other
employees. This condition could be improved, if not entirely eliminated,
by the use of a central employment agency."47This proposal found no
support among the mineowners, however:the largeroperationshad their
own personnel managers;smaller mines hired the family,kin, and friends
of foremen and other managers.
Meanwhile, Daniel Harrington helped draft a metal-mining regulatory code for Oklahoma. The code required both improved ventilation
and wet methods to control silica dust. With OPA support, the legislature enacted these regulations in February 1929. Here, too, state regulators and federal consultants furthered the interests of the larger zinclead firms. Well-capitalized companies could invest in laying water lines
and installing fans and ventilation ducts; most had already done so. On
the other hand, the law burdened small enterprises with expenses that
they could ill afford.48
Operators failed to implement fully the BOM's primary recommendation: they did not immediately terminate all men with second- and
third-stage silicosis and silicotuberculosis. The mass layoffs induced by
the economic downturn of 1928-29 seemingly offered a perfect opportunity to dispose of these individuals. Yet of those employees examined
in the year ending 30 June 1929, the proportion with advanced silicosis
actually increased over the previous year, from 3.7 percent to 3.8 percent, and the share with silicotuberculosis fell only slightly. In some
respects more humanitarian than the visiting government technocrats,
mine operators chose to lay off healthy young bachelors and to retain
older men with families to support.49
THE CLINIC AFTER THE CRASH
In the aftermath of the stock market debacle of October 1929, the
decline of the zinc industry became an outright collapse. A number of
companies immediately went under. These failures broke the Bank of
Picher, a leading financial institution in the area. When it closed at the
end of 1929, the bank was not able to cover the total deposits of the
mine operators and other customors. This bankruptcy inevitably led to
47Meriwetherto J. D. Conover,20 Oct. 1928. Meriwether'sconcern focused on unorganizeddiscontent:
there was no stirringof unionism in the Tri-Statein the late 1920s. Further,I have found no evidence that
the clinic ferretedout or gave low medical ratingsto union sympathizers.In contrast,Arizonacopper firms
Ilealth,Workers'
used physicalexaminationsto blacklistunionists.See Derickson,Workers'
Democracy,207-8.
48 D. Harringtonto RichardV. Aget6n, 6 Aug. 1927, OPARecords,unnamedbox, folder: "United States
Departmentof Commerce (Bureauof Mines) Misc. Correspondence";Meriwetherto Sayers,2 Feb. 1929,
Picher Clinic Records,box 5, file 094; Oklahoma,Session Laws, 1929 (OklahomaCity, 1929), 47-48, 51;
Harrington,et al., "Dust-VentilationInvestigation,"12-19.
49Meriwetherto M. D. Harbaugh[Secretary,OPA],7 Oct. 1929, OPARecords,envelope: "AnnualMeetings of Association:'folder:"AnnualMeeting, 1929";BOM, Silicosisand Tuberculosis-11,2; O. N. Wampler, "Safety and IndustrialRelations at Eagle-Picher,"MiningCongressJournal,Nov. 1929, 894.
DERICKSON:MEDICALSCREENING 673
others. Ore production in the district dropped from 309,436 tons in 1929
to 216,961 tons in 1930, a decline of 30 percent. Nonetheless, the price
of zinc fell 30 percent as well. The plunge continued unabated for two
more years. By 1932, Tri-Statezinc ore extraction totaled less than onethird of 1929 output. The lead business followed a similar downward
spiral. Of the 114 mills that processed ore in the district in 1929, only
15 survived through 1932.50
Workers bore the brunt of the disaster. Floundering enterprises
imposed draconian changes in the terms of employment. They made
deep cuts in wages. For example, men who ran machine drills had their
daily pay sliced from $4 in 1930 to $2 two years later. Lower piece rates
for shovelers amounted in effect to a further speedup. By 1932 the TriState zinc-lead industryprovidedjobs for only about two thousand, many
of whom worked part-time.51
These grim economic forces accomplished what Meriwether's exhortations could not. Many small operators who had not bothered to send
employees and job applicants to the clinic disappeared. Larger firms
took over some of these properties. In particular,the Eagle-Picher Lead
Company acquired numerous defunct and failing mines and became
by far the predominant enterprise in the district.52 Unvarnished Darwinism dictated health policy at Eagle-Picher. General counsel A. C.
Wallace explained the firm's method of dealing with occupational disease victims: "When they get sick, throw 'em on the dump heap."53By
the end of 1930, Eagle-Picher had instituted a "rustling card" system.
Under this arrangement managers could employ men with red cards,
signifying a rating below "C," for only a few types of positions.54
Similar policies were adopted throughout the district. Meriwether
reported in April 1930 that even first-stage silicotics and others holding
"C" cards found it "exceedinglydifficult"to get work.55M. D. Harbaugh,
Conover's successor as executive officer of the OPA, observed that by
1932 employers universally required "rigid preemployment and periodic physical examinations."This screening process, in Harbaugh'sview,
"resulted in the practical elimination of all men who could not pass."56
50 Meriwetherto
Sayers,3 Jan. 1930, Picher Clinic Records,box 5, file 093; BOM,Productionin Tri-State,
15-16; Cassidy,"Tri-StateRegion:' 18; M. D. Harbaugh,"The Tri-StateZinc and Lead Mining District in
1935"'MiningCongressJournal,Feb. 1936, 30.
51M. D. Harbaugh,"Labor Relationsin the Tri-StateMining District,"
MiningCongressJournal,June
1936, 19-21; Meriwetherto Sayers,3 Feb. 1931, Picher Clinic Records,box 5, file 093; George G. Suggs,
Union
in
the
Tri-State:
The
and
Missouri
Metal
Workers'Strikeof 1935 (NorOklahoma,Kansas,
Jr.,
Busting
man, Okla., 1986), 22-24.
52 Meriwetherto Sayers,3 Jan. 1930; Meriwetherto Sayers,5 May,4 Dec. 1930, Picher Clinic Records,
box 5, file 093; Cassidy,"Tri-StateRegion:' 250-51.
53A. C. Wallace,
quoted in "Silicosis Expose Angers Tri-StateMining Interests,' CIO News-Mine, Mill
and Smelter WorkersEdition, 30 Oct. 1939, 8.
54Meriwetherto Sayers,4 Dec. 1930; Meriwetherto Sayers,5 Jan. 1931, Picher Clinic Records,box 5,
file 093; Campbell and Mabon, "Personneland Safety,"118-19.
55 Meriwether to Lanza, 10
April 1930, Picher Clinic Records,box 14, file 401.
56
Harbaugh,"LaborRelations,'21 (quotation),20-21; Meriwetherto Harbaugh,1 July 1930,Picher Clinic
Records,box 14, file 401.
674
BUSINESS HISTORY REVIEW
It thus took economic collapse and restructuring to bring the BOM
screening plan to fruition.
The number of unemployed men in the district grew dramatically.
Some ex-minerswith advancedrespiratoryillness departed for the Southwest, where they hoped the desert climate would cure them. Others
went back to the Ozarks. The majority had nowhere to go. Destitution
spread. "They have a long bread line in operation at the present time
and it seems to be increasing,"wrote Meriwether in August 1931.57Five
months later, he estimated that soup kitchens in Picher were feeding
about 1,500 people per week. After public relief funds were exhausted,
the OPA distributed food, clothing, and fuel to a fraction of the neediest families.58
Deprivation and humiliation bred anger. Many of the jobless knew
that their low medical ratingmeant permanent exclusion from their only
occupation. At a public meeting in April 1930, unemployed miners
openly proposed dynamiting the clinic and running its employees out
of town. The meeting, attended by the mayor and police chief of Picher,
discussed this proposition, Meriwether lamented, "without one dissenting word heard."59No one blew up the facility,but Harbaugh continued
to worry about mass disturbancesand other "reverberationsof the rather
sullen and violent attitude of a great many of the workmen in the district toward the Clinic."60
Most mining entrepreneurs feared workers' compensation more than
a violent uprising of the unemployed. Hard-pressed operators dreaded
the prospect of making more than minimal charitable contributions to
the victims of industrial disease. The enactment of such protection in
Ontario had set a dangerous precedent, and in May 1930 O. N. Wampler, a safety engineer at Eagle-Picher, returned from a visit to his company's plant in New Jersey to alert his colleagues to mounting agitation
for reform in the East. Meriwether also warned Harbaugh that silicosis
and work-related tuberculosis were "becoming compensable diseases
in certain sections of the country and in other sections, large numbers
of law suits have been filed as a result of contracting such disease in
industry."Predictably, he advised the OPA to minimize its liability by
continuing to weed out disease victims. In addition, the federal official
suggested that it would be less expensive to aid victims' emigration,
presumably to the Southwest, than to risk "legal entanglements."61
57Meriwetherto
Sayers,6 Aug. 1931, Picher Clinic Records,box 5, file 093.
Sayers,4 Jan. 1932, ibid.; Cassidy,"Tri-StateRegion,"266; Jenkins,"Reportof Welfare
Department, YearEnding Sept. 30, 1930;' 3-4.
59Meriwetherto Sayers,5 May 1930.
60Harbaughto Sayers,16 June 1931,OPARecords,box:"Weekly,Monthly,YearlyProduction,etc, Reports,
1923-1939,"folder: "Clinic-General, July 1, 1930 to July 1, 1931."
61 Meriwetherto Harbaugh[Oct. 1930], Picher Clinic Records,box 5, file 091;Meriwetherto Lanza,23
May1930, ibid., file 093; John B. Andrews,"OccupationalDisease Compensation"AmericanLaborLegis58 Meriwetherto
lation Review 19 (Sept. 1929): 237-40.
DERICKSON:MEDICALSCREENING 675
As anticipated, the 1931 session of the Oklahoma legislature considered extending workers' compensation to a number of diseases, including silicosis. Aggressive lobbying by the OPAkilled the proposed reform.
The zinc-lead operatorshad little trouble convincing legislators that they
could not assume a significant share of the health and welfare costs of
production. Meriwether, undoubtedly the leading authority on silicosis
in the state, did nothing to support the movement to compensate victims of a disorder that he knew to be work-induced. In effect, demands
for compensation merely accelerated the process of eliminating impaired
employees.62
Although the specter of social insurance made the clinic more valuable to the OPA, the institution's survival became increasingly precarious after 1929. Failing operators became delinquent in their monthly
per capita payments. Skeleton crews and infrequent job openings
reduced markedlythe need for physical evaluations.Whereas 8,853 men
passed through the clinic in the year ending 30 June 1929, only 3,301
received examinations two years later. By October 1931 Meriwether was
able to perform all the medical work himself.63
The clinic director kept busy by broadening the institution's scope
of activity. Increasingly, the facility devoted its attention to diagnosis
and treatment of venereal diseases. (This was the only type of medical
therapy offered by the institution: silicotics received no treatment after
diagnosis.) Meriwether sought to convince the operators that, like silicosis and tuberculosis, syphilis and gonorrhea predisposed mine workers to costly accidents.64
The clinic also assisted at least one firm outside the Tri-State area.
After conducting its own examinations of the employees at its Manville,
New Jersey,plant, the Johns-Manville Corporation, the nation's leading
manufacturerof asbestos products, could not distinguish between pneumoconiosis caused by asbestos and that caused by coal dust. The corporation turned to Meriwether,who had investigatedcoal workers'pneumoconiosis. In the spring of 1932, he interpreted the chest X-rays of
1,140 Manville employees. Among the 810 workers for whom his extant
reports provide more information than merely "positive" or "negative,"
considerable occupational respiratorydisease emerged. Only 277 (34.2
percent) of these radiographs were negative; 327 (40.4 percent) had
"more fibrosis than normal."However, Meriwether gave Johns-Manville
only limited assistance in determining the precise cause of respiratory
disease among its many employees who had previously mined coal. To
62 Meriwether to
Sayers,5 Jan., 3 Feb. 1931;Harbaugh,"Labor Relations:'21.
63Meriwetherto Lanza,23 May1930;BOM,Silicosisand Tuberculosis-II,2; Meriwether,"AnnualReport
for the Fiscal YearEnding June 30, 1931:'3, Picher Clinic Records,box 5, file 091; Meriwetherto Sayers,
2 Oct. 1931, ibid., file 093.
64
Meriwether,"AnnualReportof Clinic Director,"22 Oct. 1930, 3, 4, 6, OPARecords,envelope:"Annual
Meetings of Association:' folder: "AnnualMeeting-October 22, 1930."
676
BUSINESS HISTORY REVIEW
be sure, he identified sixty-six cases of asbestosis and one suggestive
of bituminosis. However,he also read 117films as undifferentiatedpneumoconiosis, begging Manville's question.65This consultation probably
helped induce the asbestos manufacturer to settle out of court a number of suits brought by asbestotic employees.66
CONCLUSION
The clinic foundered despite diversification.When Congress curtailed
appropriations for cooperative projects for fiscal 1933, the BOM withdrew from the clinic partnership.MetropolitanLife also refused to renew
its commitment to the venture at this juncture. The insurance carrier
apparently had gathered enough data to estimate the financial liability
of underwriting coverage for employee groups that included silicotics.67
In July 1932, the OPA assumed sole control of the facility, renaming
it the Tri-State Industrial Examining Bureau. During five years under
government cosponsorship, the clinic had examined 27,553 miners and
determined
that 6,108 (22.2 percent) had some form of silicosis.68
Unilateral control meant that the operators had no obligation to publish the findings of the IndustrialExamining Bureau. As a private agency,
the bureau reported nothing about trends in the incidence and prevalence of respiratory disease in the Tri-State.Moreover,by 1943 EaglePicher had even stopped informing miners why they had failed examinations. According to company officials, "Experience has shown that
explanationdoes not lessen the resentment of those who are rejected.69
Thus the BOM's policy of apprising workers of their examination
results distinguished the agency from some other administrators of
employee health plans. Because medical findings were considered
proprietaryinformation, corporate physicians in this period had no obligation to share their diagnoses with their patients. Not until 1980 did
65A. M. Hughes [PersonnelManager,Johns-ManvilleCorp.] to Meriwether,17 May 1932; Hughes to
Meriwether,23 May1932;Meriwetherto Hughes,1 June 1932;Bureauof MinesCooperativeClinic,"Second
Group X-raysfor John-Mansville[sic] Co.,"31 May 1932; BOM CooperativeClinic, "ThirdGroup,JohnMansville Co. X-rays:'7 June 1932, all Picher Clinic Records,box 19, file 800.
66 BarryI. Castleman,Asbestos:Medicaland LegalAspects,2d ed. (Clifton,N.J., 1986), 137-38, 510;Paul
Brodeur,OutrageousMisconduct:The AsbestosIndustryon Trial(New York,1985), 163-64.
67Meriwetherto Sayers,6 May1932;FrancesMurdockto Lanza,2 July 1932, both Picher Clinic Records,
box 19, file 800; Kansas,State Boardof Health, IndustrialHygiene Section, PreliminaryIndustriallIygiene
Surveyof the KansasZinc and Lead Mines (Lawrence,Kans., 1937), 7.
68U.S., Division of Labor Standards,National Silicosis ConferenceReporton Medical Control,Bulletin
21, pt. 1 (Washington,D.C., 1938), 6; Harbaugh,"LaborRelations:'21; Harbaugh,"Reportof the Secretary,"16 Oct. 1934, 7, OPARecords,envelope: "AnnualMeetings of Association,"folder:"AnnualReports."
The OPAran the Tri-StateIndustrialExaminingBureauuntil 1939, at which time it contractedwith local
hospitals to provide diagnostic services. See Evan Just, Statement, in U.S., Department of Labor, Conference
on Ilealth in Tri-State,14.
69Campbell and Mabon, "Personneland Safety,"120 (quotation),119-20; Tri-StateSurveyCommittee,
A PreliminaryReporton Living,Workingand lHealthConditionsin the Tri-StateMiningArea(New York,1939),
69; Harbaugh,"Reportof the Secretary,"6 Nov. 1936, OPARecords,envelope:"AnnualMeetings of Association,"folder: "AnnualReports."
DERICKSON: MEDICAL SCREENING
677
the federal government require employers to give workersaccess to their
medical records.70
For silicotic Tri-State miners in the late 1920s and early 1930s,
knowledge did not bring justice. No one received workers' compensation benefits. Few won damages through lawsuits against their former
employers. Some received a little charity from the OPA or relief from
the county. Others returned to the family farm empty-handed. Many
entered state sanatoriums or other health-care institutions. It is impossible to determine precisely who paid all the health and welfare costs
of producing metals in the Tri-State in the 1920s and 1930s. Nonetheless, it is clear that the miners, their families and kin, and the general
public bore more of the burden than did the mine operators.71
The Picher Clinic offers one more example of the discrepancy
between the aspirationsand the accomplishments of the associative state.
Just as federally assisted self-regulation of the economy failed to prevent or abate the Great Depression, corporatist plans to protect workers' health through voluntaryassociationalefforts sufferedfrom profound
flaws and limitations. The experience of the Picher clinic sheds new
light on the truncated nature of an associative state in which no association represented the interests of workers. Corporatism without labor
virtually guaranteed neglect of the welfare of occupational disease victims. In particular, the federal officials who implemented the associative health policy failed to support compensation for disabled workers
who were discharged from their jobs. Plainly, the medical experts of
the federal government did not stand above the clash of class interests.
Nor did they catalyze a harmonious new partnership of labor and
management. On balance, the clinic fostered hostility, not harmony, in
industrial relations in the Tri-State.72
70Nugent, "Fit for Work:'590; Brodeur,
OutrageousMisconduct,157, 160, 167-68; Castleman,Asbestos,
133, 182; Occupational Safety and Health Administration,"Access to Employee Exposure and Medical
23
in
of
Office
the
Federal
1980,
Records:' May
Register,Codeof FederalRegulations,Title 29, Part 1910.20
(Washington,D.C., 1985), 85-91.
7' Cassidy, "Tri-State Region," 169; BOM, Silicosis and Tuberculosis-I, 26; BOM, Silicosis and
Tuberculosis-II, 6, 28; Tri-State Survey Committee, PreliminaryReport, 71, 77-81; R. L. Hickman to
Meriwether,20 Oct. 1931, Picher Clinic Records,box 4, file 087; Harbaugh,"Reportof the Secretary,"6
Nov. 1936, 3-5.
72 In the autumnof 1933, the Mine, Mill and Smelter Workersinitiated another militant
organizingdrive
in the district. The medical screening policy of the OPAbecame a prominent issue in this campaign and
in the violent strikein which it culminated.See Suggs,UnionBustingin the Tri-State,29ff.;Harbaugh,"Labor
Relations'"19-24.