Janet Greenlees

‘The dangers attending these conditions are evident’: Public Health and the Working Environment of Lancashire Textile Communities, c.1870–1939

This article examines the position of the working environment within public health priorities and as a contributor to the health of a community. Using two Lancashire textile towns (Burnley and Blackburn) as case studies and drawing on a variety of sources, it highlights how, while legislation set the industry parameters for legal enforcement of working conditions, local public health priorities were pivotal in setting codes of practice. The complexities entwined with identifying the working environment as a cause of ill health and with improving it were entangled within the local community health context. In addition, the multiple understandings of Medical Officers of Health surrounding the remit of their responsibilities impacted the local health context. These did not always parallel national regulations. Indeed, it was these local, community specific forces that set the public health agenda, determined its path and the place of the working environment within this.

‘For the Convenience and Comfort of the Persons Employed by them’: The Lowell Corporation Hospital, 1840–1930

The first industrial hospital in America opened in 1840 in Lowell, Massachusetts. The Lowell Corporation Hospital was sponsored by the town’s textile employers for ninety years. This article analyses the contextual complications surrounding the employers’ sustained funding of the hospital. Motivations for sustained sponsorship included paternalism, clinical excellence, business custom, the labour situation in Lowell, civic duty and the political advantages of paternalism. By analysing the changing local context of the hospital, this article argues that a broader, more integrated approach to healthcare histories and institution histories is needed if we are to fully understand the myriad of healthcare providers and their local and national importance.

‘Stop kissing and steaming!’: tuberculosis and the occupational health movement in Massachusetts and Lancashire, 1870–1918

Historians of Progressive Era labour legislation and public health have portrayed European governments as leaders in welfare provision, with the United States following their models.1 In the late nineteenth and early twentieth centuries, Great Britain, in particular, has been characterized as moving towards a ‘highly interventionist state apparatus’, after it surpassed France during the mid-nineteenth century in terms of leadership in public health reform.2 American Progressives, on the other hand, adopted many of the European urban sanitary reform initiatives. They were appealing because they ignored class and promised many community benefits.3 Yet, on both sides of the Atlantic, the relationship between the working environment and this broader urban, public health movement has largely been ignored. Medical historians have analysed cotton workers in terms of their general well being, including health, safety and compensation, or specific illnesses, such as byssinosis, and have emphasised industrial structures or the disease itself.4 They have also stressed how Europe instigated many of these reforms before their American counterparts.5 Rarely have scholars considered the urban and factory environments together. This article seeks to redress this imbalance with an example from the turn of the twentieth century when Massachusetts’ doctors transferred the urban public health discourse surrounding tuberculosis, the primary health scourge of the time, to the weaving room floor with campaigns against the occupational practices of steaming and shuttle kissing and took them to the State Legislature for action. This was in marked contrast to Lancashire where the same public health concerns could have been applied to the same weaving practices, but were not. Instead, the institutions of governance, both central, with Parliament, and local, with the town councils, as well as physicians, kept separate the urban and factory environments. This paper demonstrates that public health and medicine provide a distinct contrast to other welfare and labour issues, with Massachusetts’ reforms pre-empting Britain’s by many years. Science in relation to the ideology of health reform will only succeed if the institutions of governance, local and state, allow both policy innovation and the constituents to mobilize, and if these constituents allow the changes to be implemented.6 This importance of these relationships in the late nineteenth and early twentieth century is evident through an examination of the local and state government structures in Lancashire and Massachusetts and the responses to the working as compared with the living environment. Britain’s centralized government meant legislative decisions came from London; however, town councils played a pivotal role in the interpretation and implementation of Acts of Parliament, and in some cases, opposed them.7 Local health reforms had to be approved by town councils as ratepayers paid for them. While some town councils, such as Birmingham and Manchester, were active in battling what they perceived to be the contributors to high death rates, including poor sanitation, other councils, including Preston, Lancashire, and Bradford, West Yorkshire, were more reluctant to invest money in improving their residents’ health.8 In these towns, councillors did not believe the investment would bring sufficient return. Workplace health issues fell further down the priority list, as many town councils viewed these to be the duty of both the state, who should broaden and enforce its policies, and local employers. Furthermore, scientific and medical interest in air quality and diseases centred on the home, not the workplace or the outdoors.9 The United States’ government comprised a federalist system where more power was held by individual states than the central government in Washington, D.C. Prior to the 1930s, considerable variations in working conditions were found between states as individual state governments determined health legislation, not the federal government. Within this structure, Massachusetts was a highly autonomous political entity, being a pioneer of Progressive legislation for both labour and public health, forming a State Board of Health (BOH) in 1869. Many city governments appointed local, voluntary, BsOH in the mid-1870s, which became mandatory from 1907. From the start, local and State BsOH focused on contagious diseases, placing preventive responsibility on physicians and epidemiologists, with a methodology that combined sanitary science with social reform.10 Thus, science and the ideology of reform were incorporated into government policy at all levels. The BsOH authority grew during the latter quarter of the nineteenth century, as medical professionals’ initial fear and resentment of State intervention into what they perceived to be their domain of health waned. Urban physicians, particularly those in the larger cities of Boston, Lowell, Fall River, Holyoke and New Bedford, realized that if they helped strengthen and broaden the powers of the local and state BOH, they could extend their powers and authority. As a result, city and town BOH physicians found it advantageous to show an active interest in the effect local working environments had on their patients’ health and to seek reforms at both the local and State level.11 Industrial health was now firmly incorporated into Massachusetts’ urban and State health agendas, which allowed for public and specifically occupational health concerns to be linked.

Workplace Health and Gender among Cotton Workers in America and Britain, c.1880s–1940s

This article clarifies the differences between occupational health and workplace health and reveals how the two overlap. It unravels a multi-layered narrative about cotton textile workers’ understandings and experiences of ill-health at work in America and Britain, utilizing a combination of oral histories, government documents, company and union records, and the trade press. It aims to identify the multiple influences on contemporary debates about health at work. Contrary to current historiography, I argue that gender was only occasionally important to such discussions among workers, and that gender did not significantly influence their responses to unhealthy conditions. Workers’ understandings of, and responses to, workplace hazards were individual and related to knowledge about risk, ill-health and socioeconomic factors. American and British workers’ understandings of and responses to their working environment reveals more convergence than divergence, suggesting a universal human response to the health risks of work that is not significantly influenced by national or industrial constraints, or by gender.