Harriet Hardy

harrietHardy138 Harriet Hardy was a pioneer in the field of Occupational Medicine. Each year, NECOEM presents the Harriet Hardy Award to a person who has made outstanding contributions to the Occ Health field.

The story of Dr. Hardy’s life is of particular interest today, not alone for the reason that she is a distinguished woman physician in occupational medicine, but for how she developed her career of practice, teaching, and research in an age of technological medicine.

Take her interests first. She developed her special concerns for the health of working men and women in a medical era that was almost exclusively devoted to the hospitalized sick. In those decades of hospital expansion from the 1930s to the 1970s, Dr. Hardy’s accomplishments come from working at the margins: not in but outside the medical center – first in school and college health services and then in factory, community, and university settings. That work required special commitment to medicine’s more mundane task of prevention rather than to the dramatic cure of hospital medicine.

Her quest for the improvement of occupational health has many roots. Some might be cultural and familial. Born and raised in the Progressive Era (1900-20), she caught the reform spirit that characterized the period: men, institutions, and social conditions could be improved through political action and scientific research. Her professional search was an effort to understand diseases caused by working conditions and then an attempt to improve those conditions to prevent disease.

She joined her learning with helping action, even when that helping action meant “taking sides.” Even today (to the consternation of many practitioners), occupational medicine is not a neutral clinical-science specialty with techniques and knowledge to apply to the workplace or to the workers. For the improvement of health, occupational medicine is politics. Doctors take sides: for the company, for the workers. In this uneven exchange Dr. Hardy always remained with working men and women.

Other roots of her quest were educational. Besides that reform spirit, Dr. Hardy also developed the necessary skills and knowledge in the clinical science we call medicine, first from her medical studies at Cornell Medical School (1928-32), second from residency training at the Philadelphia General Hospital (1932-34), and then from her field work in medical practice as a school (Northfield) and then as a college (Radcliffe) physician. Out of these early practice beginnings in educational environments, she found time to conduct clinical studies of student populations: when did menstruation begin? Do low blood pressure and anemia cause symptoms? Does an elevated white blood cell count (WBC) mean infection? From such school and college studies old myths were exploded – that low blood pressure and mild anemia caused symptoms and that elevated WBCs were always an indication of infections when they could, in fact, be due to menses. Such research in the field of healthy young adults was quite distinct from the laboratory investigations so characteristic of hospital medicine.

Still other roots were the encouragements of her mentors at the Massachusetts General Hospital, Doctors James H. Means and Joseph Aub. For in 1945, at the age of 39, Dr. Hardy moved from clinical work with young adolescent women, taking her first job in occupational medicine with the Massachusetts Division of Occupational Hygiene. There she was assigned to investigate a hepatitis outbreak (which she wrote up) and then those cases of “Salem Sarcoid” that we know today from her distinctive work as beryllium disease. This enterprise joined her clinical skills in the examination of patients, her experience in organizing field work studies, her research interests in solving the problem of a new disease, and her reform spirit in improving the health of workers. Looking back, one might argue that her years as school and college health physician were really occupational medicine in disguise, working as she was in schools – call them learning factories – and dealing with students – call them workers – while contending with teachers – the management. In any event, she had been prepared, if not from graduate school, then from on-the-job experience in practice and in this field.

The story of beryllium disease with the resistances and delays in its recognition by the profession, government, and industry is well known. Putting those brief years of resistance aside, the control of the disease remains a remarkable success story in the annals of occupational medicine and the personal achievement of Dr. Hardy. Following her recognition and description of chronic beryllium disease, substitutes for beryllium were found in 1949. Take this very brief period of five to six years for industrial control of beryllium as a contrast to the control of mine dust diseases. These diseases were noted by Ramazini in the Middle Ages but continued for centuries, even after the invention of the exhaust fan. After her beryllium disease studies, Dr. Hardy’s clinical-research and pedagogical interests grew, leading her to an awareness of the hazards of lead, cadmium, asbestosis, and coal mine dusts and into educational fields. Her educational interests are represented in that fine general text coauthored with Dr. Alice Hamilton, Industrial Toxicology, and in her lectures to undergraduates and post-graduate courses on her favorite theme: man-made disease. Then from the 1950s there was her special job at the Massachusetts Institute of Technology as director and founder of their Occupational Medical Service. Later came her appointment as the first women professor at Harvard Medical School and her appointment at Dartmouth Medical School, to mention but a few distinctions.

Having sketched this development of Dr. Hardy’s career, what can we say about her attributes that made her career possible? Occupational medicine is working at the margins where creative things can and are done, but it is a lonelier outpost than the medical center, requiring her attribute of stick-to-itiveness.

Her field work, meeting workers in their homes after working hours, she may have also learned in her earlier private practice in Northfield, where patients were waiting for her because they were sick. Nonetheless, she did not give up that special home encounter and the extra work and effort it required to visit workers off-hours at home and at their own convenience.

In the care of patients she demonstrated personal concern, an ancient tradition of medicine’s art. As a practitioner and investigator, she worked with disabled patients as their personal doctor, sometimes their consultant, not in one-visit contacts but in long-term care, from which she knew the circumstances of their lives as well as the natural history of their disease. With colleagues she was always direct and honest, for some, perhaps unsettling. Despite her patrician background on both her paternal and maternal sides, she easily related to working people and the issues of concern to them. Finally, she has that attribute of working hard at her own occupation of occupational medicine, for how else would she have done so much useful work! Her autobiography, Challenging Man Made Disease, published in 1983 by Praeger Publishers, tells that story.

Written by and used with the permission of John D Stoeckle MD, Professor of Medicine Harvard Medical School. June, 1983


 

Watch an interview with Harriet Hardy, on being awarded the 1988 Alice Hamilton Award by the Occupational Health and Safety Section of the American Public Health Association (APHA).
Full Interview

Interview clips:
Harriet Hardy Recalls Her Early Days With Alice Hamilton
Harriet Hardy Recalls Her Work Discovering Chronic Cadmium Poisoning
Harriet Hardy reflections on Occupational Medicine Training