"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 Accessed: 10/05/2008 07:34 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/action/showPublisher?publisherCode=pfhc. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission.

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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.

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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.

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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.

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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.

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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

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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.

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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

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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.

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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.

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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.

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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."

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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."

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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.