The physician of Packingtown:the life and impact ofDr Caroline Hedger

Benjamin D. McLartyRucks Department of Management, Louisiana State University, Baton Rouge,

Louisiana, USA, and

Peter A. RosenSchroeder Family School of Business Administration, University of Evansville,

Evansville, Indiana, USA

Abstract

Purpose – The aim of this paper is to illustrate the instrumental role of physician Caroline Hedgerduring the first half of the twentieth century, with her emphasis on worker health, which influencedAmerican society and helped to improve working and living conditions of people across the USA.

Design/methodology/approach – Drawing on archival newspaper clippings, original journalarticles and books written by the subject, historical manuscripts and other labor history resources, thismanuscript pulls together information on this topic in a unique way to give a broad view of the impactof Hedger and her important role not only for the city of Chicago, but the nation as a whole.

Findings – This research concludes that Hedger was an instrumental force and tireless advocate forthe improvement of public health and social change. She was a constant driver for the creation ofbetter living and working conditions of poor laborers, especially immigrants and women, desired theenhancement of child welfare, and was also helpful in supporting the labor movement and educatingthose involved in the process.

Originality/value – This is the first manuscript to explore the role played by Caroline Hedger inrelation to her impact on the importance of the health of workers and their families. Her story is atestament to the powerful effect of a single person in a dynamic world, and demonstrates howunderstanding a worker’s health contributes to greater insights about management history.

Keywords Labour, Working conditions, Management history, Caroline Hedger, Packingtown,Public health history

Paper type Research paper

In February, 1906, Upton Sinclair published his novel The Jungle, which graphicallydescribed the living and working conditions of the residents of Packingtown, a Chicagoslum located next to the stockyards district of the city (Sinclair, 1906a, b; Braeman,1964). Sinclair was a young aspiring novelist and socialist who believed that his workwould awaken a stronger movement in the US for labor reform and a pro-socialistagenda. The impact of his novel; however, was much different than he expected, as thepublic focused on the unsanitary meat-packing conditions and the woefully inadequategovernment inspection system that was in place to monitor it. “I aimed at the public’sheart,” Sinclair stated, “and by accident I hit it in the stomach” (Sinclair, 1906a, p. 594).Despite lamenting the effect of his work, The Jungle was a powerful piece of fiction thatmotivated a strong response. Initially, readers were skeptical of the claims made in thenovel, but its popularity spurred the people in the Packingtown community to take

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action to confirm claims’ veracity. In May, 1906, the magazine The World’s Workpublished three compelling articles concerning Sinclair’s claims under the overall titleof “Selling Diseased Meat” (Braeman, 1964). One of these articles was written by afemale physician named Caroline Hedger and was titled “The unhealthfulness ofPackingtown”.

In this article, Dr Hedger vividly described the living and health conditions underwhich the inhabitants of this neighborhood lived. Along with the articles titled “Apicture of meat inspection” by W.K. Jaques and “The failure of Government inspection”by Thomas H. McKee, these pieces gave credibility to Sinclair’s descriptions andprompted President Theodore Roosevelt to take action (Braeman, 1964). This led toinvestigations by the federal government in the form of the Neill-Reynolds Report,which largely confirmed the horrific conditions described by the articles in TheWorld’s Work and The Jungle. The report described how thousands of meatpackingworkers were compelled to work under conditions that were a threat not only to theirpersonal health, but to the health of all who consumed the food products that theyprocessed (Neill and Reynolds, 1906). The impact of the Neill-Reynolds Report onPresident Roosevelt was striking, as he subsequently fought to overcomecongressional opposition to pass reforms that increased the policing powers of thefederal government (Braeman, 1964; Cooper, 1990). These powers came in the form ofthe Federal Meat Inspection Act 1906, which required and funded federal inspectors inall packinghouses whose products entered interstate or foreign trade (Wade, 2005). Formany readers of The Jungle, the story finishes here. Federal intervention resulted insafer food processing and the public’s health was ostensibly secured. Unfortunately forthe residents of Packingtown, this increase in oversight did nothing to improve theirpersonal situations. In most cases, the observers of the meatpacking process seemed tohave more pity for the slaughtered pigs and concern for the quality of their meat thanfor the men and women who turned it into bacon (Horowitz, 1997).

Resourceful and intelligent individuals like Dr Caroline Hedger, however, would notallow these conditions to go unnoticed, nor would she fail to spend her life trying toimprove them. Similar to other female reformers who worked in the same era such asthe Nell Nelson, author of The Chicago Times’ “City Slave Girls” series (Liguori, 2012),or Jane Addams, another noted Chicago area reformer and recipient of the 1931 NobelPeace prize (Nobelprize.org, 2012), Hedger would influence the development of bothlocal labor movements and national worker health reforms. In this way, she played animportant role in management history through her impact at multiple levels ofinvolvement in workers’ lives both on the job and in their homes by helping to ensuretheir family’s well-being.

Caroline Hedger was born on January 12, 1868, in Braceville, Ohio (Russell, 1922) toJohn and Maria (Caskey) Hedger (Leonard, 1914). Hedger was a well-educated woman(see Plate 1). She attended Willoughby High School, Berea College in Kentucky from1887 to 1888 and Wellesley College from 1889 to 1890 (Clark, 2001). Between 1890 and1899 she trained and worked in nursing and was a graduate of the Illinois TrainingSchool for Nurses (Cameron, 1919). She obtained a medical degree from NorthwesternUniversity Women’s Medical School in 1899, with an emphasis in internal medicine.She then acquired a second degree in medicine in 1904 from Rush Medical College(Clark, 2001). It was during this period that she began living in the Packingtown

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community and started the work that would have national influence in relation to TheJungle.

Living conditions in “The Jungle”As reports by Hedger and others later confirmed, the descriptions of living conditionsin the Packingtown district were quite accurately described by Sinclair’s (1906a) novel.The owners of the largest meatpacking operations, Philip Armour and Gustavus Swift,never discouraged the development of the deplorable tenement community outside oftheir enormous production facilities (Horowitz, 1997). Sometimes referred to as the“Back of the Yards,” the community in which the meatpacking workers lived wasabysmal. Surrounded on all four sides by unbearable odors, smoke, human and animalwaste, disease, and refuse, Packingtown was a geographic eyesore (Miller, 1996) (seeFigure 1).

In a report on the housing situation in the neighborhood, it was stated that “No otherneighborhood in this, or perhaps in any other city, is dominated by a single industry ofso offensive a character. Large numbers of live animals assembled from all sections ofthe country, processes of slaughtering and packing, the disposition of offensive animalwaste, constitute an almost unparalleled nuisance” (Breckinridge and Abbott, 1911,p. 434). The report further stated that in the stockyards, “are the mingled cries of theanimals awaiting slaughter, the presence of uncared-for-waste, the sight of blood, thecarcasses naked of flesh and skin, the suggestion of death and disintegration – all ofwhich must react in a demoralizing way, not only upon the character of the people, butthe conditions under which they live” (Breckinridge and Abbott, 1911, p. 435).

Plate 1.Dr Caroline Hedger

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Hedger documented that the houses in the district were “small and mean” built on lowlying wetlands with an average of four families per dwelling (Hedger, 1906, p. 7507).Each typically had four adults per bedroom, and any number of children as well. Thisovercrowding led to as many as 113 persons living per acre in buildings closelyhuddled together under conditions that hindered sleep. This population densitysurpasses that of modern cities such as Delhi, India and Manila, Philippines (UN, 2006).Rent and mortgage payments for these homes were relatively high in comparison toprevailing wage rates, causing the residents to accept boarders. This further increaseddiscomfort and overcrowded conditions. If the tenants complained and landlords wereforced to make improvements, the result was an increase in rent. This furthercompounded the problems faced by the tenants and encouraged them to tolerate theirpoor living conditions. For example, a small, dark basement of four rooms went for$8.00 per month to two families. Mortgage payments on a small cottage ran as much as$12.00 per month for one family, but this excluded city taxes, paving and sidewalkassessments, and water taxes. In one case, a father of a family of seven paid theseexpenses from a wage of $0.25 an hour for only 29 hours per week (Hedger, 1906). Thisleft little money for buying food and other necessities. In almost every case, the familiesthat were composed of newly arrived immigrants were exploited the most, paying thehighest rent for the poorest apartments (Breckinridge and Abbott, 1911) (see Plate 2).

Figure 1.Map of Packingtown

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Many families were forced to live on meals of coffee and bread, contributing to anemicchildren and poor worker health (Hedger, 1906). The number of establishmentsproviding alcohol to the workers of Packingtown was immense. Outside of thestockyards stood 45 saloons on a two block stretch called Whiskey Row. Althoughoffering relatively inexpensive food, these saloons encouraged the consumption ofalcohol and offered inviting places for workers to eat their meals. The lack of nutritiousfood also had the effect of decreasing the inhabitants’ ability to fight off disease(Hedger, 1906). Disease in the Packingtown neighborhood was amongst the worstfactors contributing to the poor living conditions. The number of tuberculosis cases inPackingtown was near the highest in the nation (Hedger, 1906). Given the lack ofnourishment and the poor quality of air prevailing in the neighborhood, residents wereideal victims for tuberculosis germs. The environment faced by the workers and theirfamilies was a significant determinant of their unhealthy constitutions, according toHedger, who was quoted as saying, “The poor health of these children is directlytraceable to bad sanitary conditions . . . both along Bubbly Creek and surrounding thisdump at Forty-seventh and Robey streets” (Chicago Tribune, 1909). The presence ofthese disease fostering conditions enhanced the need for reformers like Hedger to comeon the scene and expose the truth of the situation to the world. In this way, it was hopedthat owners like Swift and Armour would be compelled to take action and provide thepeople involved with the income needed to care for their families. Individuals likeHedger could also provide the education necessary to prevent the spread of diseaseamong the workers and their families.

Plate 2.Packingtownneighborhood alley

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Working conditions in “The Jungle”The slaughtering process in the meatpacking plants was brutally efficient yet lackingin sanitary necessity. Animals were transported to the stockyards by rail, brieflyhoused in outdoor pens, and brought into the meatpacking plant in mere hours (Miller,1996). For example, hogs were herded up an inclined chute and hooked by chains to alarge wheel that lifted them as it rotated and carried them to an overhead railway. Thisrail ran on a descending angle through the length of the plant from the top to thebottom floor. As it descended, a pig’s throat would be sliced open and the bloodcollected for fertilizer. Further down the track, it would be released into a vat of boilingwater that scalded it and loosened its hair and bristles before its pink carcass wasremoved and placed in a scrapping machine that shaved its body. It was then hitchedup again by the overhead rail and gravitated to a yet lower section of the plant whereworkers butchered it as it glided by. On its final leg down to the lowest point of theplant, a pig was cut down the middle and the halves were pushed into chilling rooms tofirm up in preparation for further processing. This sequence took less than ten minutesin total (Miller, 1996). From the stockyard pens to butcher shop destinations, themeatpacking companies became increasingly vertically integrated allowing for theirdomination of the entire industry. This domination was further enhanced when theowners of the largest meatpacking operations, including Armour and Swift, began tocollude by allocating sales territories and setting wholesale meat prices (Horowitz,1997) (see Plate 3).

In these meatpacking houses the workers were the machines, each with a highlysimplified task that could not be replicated by a mechanism due to the irregular size,shape and weight of the animals coming through the line (Miller, 1996). Thus, divisionof labor was the key in this process as the use of machinery was exceedingly difficult(Horowitz, 1997). This highly sophisticated level of organization was modeled aftercrude assembly-line operations first developed in Cincinnati before the Civil War

Plate 3.A bird’s eye view of

Armour & Co. UnionStockyards

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(Miller, 1996). They would serve as the inspiration for Henry Ford’s Model Tassembly-line years later. As Ford reminisced, “The idea came in a general way fromthe overhead trolley that the Chicago packers use in dressing beef” (Ford andCrowther, 1922, p. 81).

By the 1880s, the meatpackers of the stockyards were speeding up work to cut costsand increase their profits. Not only did they divide up the work itself into a piecemealfashion and take out all of the skill involved, they forced their workers to labor at anever faster pace. Overhead trolleys were used to move swine carcasses at increasinglyfaster rates along slaughtering lines and “pacers” were used in beef houses toencourage workers to labor faster by barking at them like galley slaves (Miller, 1996).With increased speed came increased danger, as the workers stood on slippery floorswith sharp tools, often in unheated facilities, leading to severe cuts and consequentinfections from dirty work conditions (Horowitz, 1997). This devotion to speed,efficiency, and the lethal motions required by meat cutting mirrored the advice fosteredby the Scientific Management movement that was being developed by FrederickTaylor and his colleagues (Horowitz, 1997). The sanitation conditions within thepackinghouses, however, could not have met with Taylor’s approval. In her report,Hedger (1906) documented that dirt, blood, animal waste, stale air and other materialwere prevalent, which further encouraged the growth of tuberculosis germs. Thefreezing temperatures of the winter months and the refrigerated processing roomsoften encouraged the workers to put their cold feet into the steaming meat carcasses(Miller, 1996). Lack of respirators for workers in can painting rooms resulted in theminhaling so many vapors that their sputum was blue. Toilet facilities and changingrooms for women were limited and often overcrowded (Hedger, 1906).

Philip Armour, owner of Armour and Company, espoused the philosophy of the beefkings, “It is the aim that nothing be wasted“ (Leech and Carroll, 1938, p. 46). “I pack . . .everything but the last breath of a hog” (Gunsaulus and Philip, 1901, p. 172). In manyways, however, Armour was more of an organizer than an innovator, as he waged arelentless fight against waste and inefficiency in his business operations, using whathe called “scientific business methods” (Gunsaulus and Philip, 1901, p. 172). He usedwaste to eliminate waste by processing horns, hoofs, sinew, fat, intestines, bladders etc.to create glue, margarine, sausage casings, fertilizer, hairbrushes, buttons and otheritems. In this way meatpackers could claim that they were reducing pollution byturning it into profits. These efforts to increase efficiency and reduce waste appeared tobe noble, but they had the unfortunate result of increasing the use of material thatshould have been discarded when diseased materials were utilized (Miller, 1996). Bycreating efficient systems to capitalize on every potential benefit of the slaughterhouseindustry, Armour and Swift embraced many of the same concepts as Taylor byeliminating antiquated heuristics for production systems and developing processesthat relied on careful research and questioning. Taylor believed that ScientificManagement could be used as an instrument for greater productivity, greaterpurchasing power and a higher standard of living (Wren and Bedeian, 2009). The lastof these three benefits was clearly not the emphasis of the meatpacking plant owners.The harsh treatment of the employees and the unsanitary conditions of the workencouraged reformers like Hedger and others to expose to people outside ofPackingtown what was happening in this area. It also encouraged the development ofthe labor movement in the Chicago area (Horowitz, 1997; Miller, 1996) (see Plate 4).

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Labor unions in “The Jungle”Multiple unsuccessful attempts at unionization were made by the stockyards districtemployees. Strikes in 1879, 1886, and 1894 all failed, as the meatpackers hiredreplacement workers, and state militia, Pinkerton agents, and local police contributedin defeating their efforts (Miller, 1996). Armour forced his employees to sign contractsagreeing not to join unions and systematically blacklisted union organizers. Labororganization was also hindered by divisions between the workers themselves due toethnic and skill differences. The Irish and German workers deeply resented theunskilled Eastern European immigrants’ willingness to take their jobs. Later migrationby black workers to the city from the south further increased these divisions, andallowed this non-union environment to prevail. It would not be until the 1930s thatserious labor reforms would take place leading to the formation of the UnitedPackinghouse Workers of America (UPWA; Horowitz, 1997). Armour believed that theonly answer to the labor issue was to be what, in his opinion, was a good employer. Hereasoned that he must drive his laborers as he did to keep production costs at aminimum, lowering prices for the product and, therefore, enabling him to employthousands of individuals. The best that any employer could do was to provide the jobsthat the people desired (Miller, 1996). This perspective is referred to as the minimalistview of Corporate Social Responsibility indicating that a business needs only to paytaxes and obey the law to do its duty. Employing workers and providing goods and

Plate 4.Dressing beef and the

slaughtering floor, Swift& Co.’s Packinghouse

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services at reasonable prices is the only social obligation when this view is held (Boveeand Thill, 2011). Once again it is hard to imagine that the proponents of ScientificManagement would approve of the harsh treatment of these employees despite theirviews regarding the issue of union formation (Wren and Bedeian, 2009, p. 151). Taylorwas adamant in his argument that Scientific Management should emphasize both acommitment to scientifically sound techniques and friendly cooperation betweenemployees and management (Nyland, 1996). His work clearly indicates that he believedthat paying employees a fair wage and fostering friendly cooperation betweenemployees and management would eliminate the need for union formation (Wren andBedeian, 2009).

Hedger’s impact on PackingtownDr Caroline Hedger faced these conditions when she moved into the University ofChicago settlement house in Packingtown near the beginning of the twentieth century.Settlement houses were institutions developed in the late nineteenth century to helpcombat poverty, especially among immigrants in overcrowded industrial cities (Wade,2004). Hedger’s article “The unhealthfulness of Packingtown” in The World’s Workmagazine may have had one of the most significant impacts on the national landscapeof all her work (Hedger, 1906). In it she describes in devastating detail the living andworking conditions of the laborers in the Packingtown neighborhood as previouslydescribed. Hedger did not back down from confronting the powerful beef producers.The article ends with several significant and strongly worded recommendations toimprove the current state of affairs in the stockyards district, “for their own sakes theAmerican people should consider the health of the 32,000 packinghouse workers, acenter of infection by tuberculosis. . . It must be realized in Packingtown that theworkers are human beings and must have decent living and working conditions”(Hedger, 1906, p. 7510). She further argued that overcrowding must be reduced andinspections of living facilities conducted. Legislation should also be passed to protectwomen and children in industry. Education must be provided to the residents oncooking and proper ventilation. Last, there must be a search for and treatment of allearly symptoms of tuberculosis to make Packingtown a habitable and healthycommunity (Hedger, 1906). As noted, this article was published with two others in TheWorld’s Work that detailed the failures of government meat inspection and addedcredence to the claims made by Sinclair in The Jungle. Ultimately, this led to reformswithin meatpacking plants, but outside of the plants was a different story. Her calls forreform were noble and had much foresight, but change would come slowly for thepeople of Packingtown.

Several years after The World’s Workpublication, Hedger was instrumental in astudy of the children of the Packingtown neighborhood and wrote a compelling piecefor the 1912 International Congress on Hygiene and Demography. This reportconcluded that low wage levels were a direct cause of children’s poor schoolperformance, and furthered the cries of social reform for the Packingtown families.According to her data, nearly 50 percent of the schoolchildren in Packingtown were insome way delayed in their normal academic development (Hedger, 1912).Proportionally, the children of the immigrant families were among the mostdevelopmentally delayed. Normal boys were noticeably taller and heavier than thoseconsidered delayed. The underdeveloped children had other characteristics in common,

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namely, they were “saturated with tea and coffee” (Hedger, 1912, p. 4). Underdevelopedchildren also tended to have more physical ailments such as enlarged glands,hypertrophied tonsils, adenoids and anemia. The anemic children tended to reside inpoorly ventilated homes with greater levels of smoke present in the air. Tuberculosisdeaths were estimated at ten per 10,000, which was well above average for the city ofChicago. These children were more likely to repeat grades or leave school early tobegin laboring in the stockyards to help support their families. Hedger’s findingsshowed that families of these children were more likely to have higher mortgagepayments and higher taxes, which affected their economic ability to provide propernutrition for their children. Families who were missing fathers were also more likely tohave developmentally delayed children. These results led Hedger to conclude that thisissue was directly related to family income levels. Hedger concluded her report bystating “These children, as a whole, are bad physically, and should be improved, but itis the ones who get enough food, who have more room to live, more chance to sleep in aless crowded bed, less worry from taxes and mortgages, that have the spirit and thenervous balance to make their grades” (Hedger, 1912, p. 19). These children were mostlikely not victims of true mental or physical disorders, but rather malnourished anddistracted by their substandard living conditions which interfered with their attemptsto be academically successful. By shedding light on this issue, Hedger emphasized theneed for further reform in the neighborhood. Only through improving the economiccondition of these families and providing educational support to these children couldthey become productive members of society (Hedger, 1912).

Whereas her contribution to exposing the living, working, and health conditions ofthe residents of Packingtown were profound, Hedger’s entire career demonstrates herdesire to be a force for positive social change. Throughout her life, she workedtirelessly to educate others about the need for improved public health, better workingconditions, better parenting, naturalization of immigrants, women’s suffrage, andmultiple other worthy causes. The following discussion summarizes multiple aspectsof her life’s work and demonstrates the efforts she made to be a positive influence onAmerican society. Her emphasis on the health of workers and their families is an oftenoverlooked issue in the evolution of management history over time. Her efforts toimprove the health of workers and their families had a direct impact on managementpractices by further emphasizing the importance of the relationship between healthypeople and successful business operations.

Women’s issues at workIn 1909, Hedger was a member of the first American Conference on the Prevention ofInfant Mortality sponsored by the American Academy of Medicine. At the conference,she delivered a speech regarding the correlation between women working long hoursand their children’s mortality. This issue was crucial because at the time over 6 millionwomen worked in industry. She suggested shorter hours, better sanitation, and betterprenatal care. She also described the need for more accurate accounting of birth ratesand other vital statistics to get better data to understand the scope of the issue (DallasMorning News, 1909). In 1911, she participated in numerous committees for a ChicagoChild Welfare Exhibit held at the city Coliseum (Clark, 2001). Hedger was veryconcerned about the lasting impact of long work hours and limited education forwomen and its impact on infant mortality rates. She believed that intense physical and

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nervous strain, lack of prenatal care, pregnancy’s effects on a woman’s ability to workand the inability to breast feed while working all negatively impacted the chances ofrearing healthy children (Clark, 2001). While it is true that many immigrant familieswere large and women were still able to have children despite high mortality rates,Hedger was primarily concerned with women and their capacity to parent due to theharsh living conditions that resulted from their economic status. She expressed theseopinions when addressing the Women’s Trade Union League (WTUL) of Chicago in aspeech titled the “Toxin of Fatigue.” In this speech she expressed her views thatcurrent labor conditions created a negative impact on quality of life which hindered theability of women to successfully run their households and rear children (ChicagoRecord-Herald, 1911). Her concern for worker fatigue also mirrors that of otherprogressive people of her day, such as Frank and Lillian Gilbreth, who used motionstudies to improve jobs for workers by reducing unnecessary and tiring movements(Gilbreth and Gilbreth, 1916). The objective of the Gilbreths was to eliminate motionsand decrease worker fatigue so that productivity could be enhanced. They believedthat a fundamental benefit of their research would be a greater consideration ofworkers and their welfare including their physical, mental, and general well-being(Wren and Bedeian, 2009). This reduction in fatigue would have obvious healthbenefits of which Hedger was mainly concerned. She served as one of the staffphysicians for the WTUL in the hope that her availability as a physician woulddecrease the cost for a woman seeking medical attention at the outset of an illness in anattempt to prevent what otherwise might be an expensive or dangerous disease (Clark,2001). Her efforts to prevent infant death were highlighted during the summer of 1911,when she mobilized nurses across the city of Chicago to provide much needed care forsick babies due to the excessive heat. Her supervision led to a dramatic drop in the rateof infant deaths (Dallas Morning News, 1911) and impacted numerous people.

Through her involvement in the WTUL, Hedger continued her efforts to save thehealth of Chicago women in the fall of 1913. Addressing workers from the BinderyWorkers Union and Laundry Worker’s Union, her emphasis was on preventativemedicine, as there was an alarming increase that fall in women suffering fromtuberculosis (Day Book, 1913a). With the help of three medical specialists, Hedger wasin charge of examining every woman in the league of unions comprising the WTUL ofChicago. By designing an assembly-line of sorts, each woman was given an eyeexamination, followed by a throat and lung exam in succession by the specialists. Inthis way each was provided with a thorough exam in an attempt to identify anyonewith cautionary symptoms (Day Book, 1913b).

Hedger decried the strenuous lifestyle forced upon the average young woman inChicago expressing her beliefs that intense labor would render these workersphysically incapable of motherhood. Describing the thousands of young women whowould not know the joy of motherhood due to the poor health they suffered from as aconsequence of their sweatshop labors, an audience of mostly mothers at a conferenceof working women’s issues was greatly moved by her statements. “People have been socarried away with the economic necessity in the last fifty years that a girl has neverbeen considered as a race factor. She has been judged as an earning power, not as afuture mother. The question now is to have girls capable of both earning money andbecoming mothers” (Day Book, 1913c, p. 2). Hedger went on to emphasize the need formore leisure time and a normal rhythm for women in both the working world and in

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their educational pursuits so that they would be able to become healthy mothers. Whileit is highly unlikely that the intense labor performed by these women directly led toproblems of infertility, these statements indicate that Hedger may have been an earlybeliever in a more balanced approach to home and work related issues.

Public healthHedger had strong opinions about the importance of public health issues. This wasespecially true as it related to public health nurses (Hedger, 1916). Public health nurseshad to deal with very challenging working conditions and were responsible for shapingnot only the health of the individuals they worked with, but their entire community. Inher view, the emphasis on curing disease limited a nurse’s ability to prevent futuredisease. By training health care workers solely about the problems of disease, they hadno idea about what proper health should look like. Improving this condition couldeventually lead to greater public health as a whole. In Hedger’s opinion, nurses shouldbe allowed to study social problems and work with members of a community as part oftheir training above and beyond the routine of hospital life in the typical nursingschool. This broader practical education would lead to increased progress in overallpublic health (Hedger, 1916).

Hedger believed that industries had a responsibility to improve hygiene issues notonly through bi-annual examinations, but by health education, proper housing andquality food for their employees (Hedger, 1916). Industrial neighborhoods shouldreceive public health instruction from the industries attached to them. This was neededfor American industry to ensure its own protection, survival, and continuedsupremacy. In her view, industry had already drained the labor pool from Europeanimmigration for short term gain, but must realize the importance of labor in the future.She believed that the industry that has a future is the one who conserves its workforceby implementing health measures in its factories and in the homes of its employees forthe long term. Industry must prevent disease to ensure its own preservation (Hedger,1916). Her prescriptions for industry were very forward thinking and in many wayswould be adopted in the future. Modern concepts of sustainability that seek to preservehuman capital resources and the implementation of safety and health standards by theOccupational Safety and Health Administration (OSHA) Act of 1970 reflect this notion(Bovee and Thill, 2011).

Hedger believed that the community itself must also recognize the crucialimportance of public health as a good investment. In her view, prevention was lessexpensive than dealing with community problems later down the road. Knowing thisshould energize every community member to take action and demand positive healthinstruction without the use of fear. In her view, taxation should be reformed to fundschool nurse programs. Hedger believed it was important for public schools to havenurses on staff to care for children, especially for those of immigrant families (Hedger,1916). She thought it was criminal that teachers were forced to waste their timeworking with children that were unable to receive instruction due to preventable healthproblems. Her views on nurse training, industry support and wider communityinvolvement, demonstrate a forward thinking attitude regarding the importance ofhealth and laborers. Not all of her ideas regarding these issues would be implemented,but many of them are arguably being debated even in today’s social environment.

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Americanization of immigrant workersAfter being hired in 1916 by the US Department of Labor to study conditions ofmothers in rural areas, Hedger wrote numerous articles between 1917 and 1924 thataddressed issues associated with issues of the Americanization of immigrant workersand their families (Clark, 2001). The Americanization movement was a response to thelarge number of immigrants arriving in the US in the early part of the twentiethcentury. This movement sought to integrate immigrants into American society(Barrett, 1992). Heavily influenced by her experiences in the stockyards districtworking with the immigrant families of Packingtown, Hedger was sympathetic tothese newcomers and wanted to ease their assimilation into mainstream Americanliving. She believed this process would help workers and their families to be bettereducated and healthier. She encouraged the teaching of English and better childcarepractices to immigrant families and helped foster these activities in both Chicago andNew York. She feared that the language barrier would prevent immigrant familiesfrom using American medical facilities for themselves and their children (Clark, 2001).By Americanizing immigrants, fears of modern medical techniques, helplessness, andisolation could be reduced in this population. Hedger was able to combine her effortstoward decreasing infant mortality and increasing immigrant Americanizationthrough the publication of her book The Well Baby Primer in 1919. In this work,immigrant women were instructed in the proper care and treatment of their babieswhile at the same time learning how to read English. The book contains numerousreferences to healthy eating and cleanliness, with dozens of photographs and cartoonsof babies to accompany the good practices. At the end of the book there is a sectionabout birth certificates and the naturalization process for parents to become Americancitizens. This book embodies much of Hedger’s life’s work and clearly demonstratesher desire for maintaining children’s health and the socialization of their parents(Hedger, 1919).

Nursing reformsOf particular personal importance to Hedger was the health of the people that werecaring for the sick. With her background in nursing, she understood very well theissues involved. Positive health was a concept that she strongly supported for thenursing community (Hedger, 1922). In her view, nurses must be healthy themselvesbefore they could be expected to provide health care to other people. These ideas aboutpositive health were certainly not simply the absence of disease, but a proactiveapproach to dealing with personal health (Hedger, 1922). By having positive health,Hedger believed that nurses could maintain their vigor, be able to rely on their bodiesfor the demands of work, and still have something leftover for themselves when theirwork day was finished. She also believed that positive health could be enhancedthrough activities that let one “grow a soul” (Hedger, 1922, p. 13). By developing asense of art, beauty, and music, life would be more fulfilling and more balanced. Inother words, she encouraged nurses to develop hobbies. She gave the example of howshe herself, despite her hard work, had learned to play the piano at the age of 52. Indeveloping this new skill, she described the experience as “more fun than anything . . .to begin a new avocation at an advanced age” (Hedger, 1922, p. 13). A nurse needed ahobby such as this that “builds up her ability to create, something that fills her soul,something that helps her into the realm of beauty and something that she understands

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and has an interest in outside of nursing” (Hedger, 1922, p. 14). These views may beconsidered another early argument for work-life balance. Positive health would alsoallow nurses to conserve themselves for the other important duties of their lives.Hedger’s views for positive health and balance between work and leisure would be acommon theme throughout her career and are still important in today’s society.

Social changes and lawsThroughout her life, Hedger had many progressive views on changes in society andneeded legal reforms. She once said this of the residents of Packingtown, “one cannotblame these people for not keeping clean . . . a living wage is not paid. The women aretoo busy fighting for a living to be able to do anything for their children, much lesskeep their homes in order” (Chicago Record-Herald, 1910). She urged that a state law bepassed that would regulate nurseries and set healthy standards of care for children.According to her point-of-view, “We are killing our own future citizens by the failure tohave legal safeguards over their health and lives” (Chicago Record-Herald, 1910). Shealso expressed her desire for laws to be passed that required both men and women toprocure a clean bill of health before being allowed to marry (San Jose Mercury News,1910). Hedger was also an advocate for women’s suffrage. She believed that givingwomen the power of the ballot box would indirectly improve infant mortality ratesthrough the influence of female voters. “[A]dequate public institutions to care forneglected or orphan babies, either through death or law, would provide a mother foreach baby, and would regard the rearing of a human being with more solicitude nowaccorded the rearing a horse or a cow” (State, 1911, p. 3).

When speaking to a gathering of WTUL members in Chicago in the spring of 1911,Hedger made pleas for the adoption of an amendment to the women’s ten-hour laborlaw, which would restrict the work week to 54 hours. “We wish to attain and maintaineconomic efficiency. We wish to have social and family relations and we wish to havean effect on the future.” Increased fatigue through overwork could be reduced byproper eating, but most especially through adequate sleep, which is much needed bythe working woman. “You can’t lose six hours’ sleep one night without paying it back.If you don’t pay it back soon then you will have to pay it back with interest later on,and you may overdraw your bank account of health and go bankrupt.” She stressedthat working women must have more time to learn about these issues and to focus ontheir families (Aberdeen American, 1911, p. 3).

Other career highlightsFor nearly 25 years Hedger served as a medical consultant for the ElizabethMcCormick Memorial Fund (EMMF). She started work with the EMMF in 1920, to helpfulfill its goal of studying the conditions of children and making efforts to promotetheir health, happiness and general welfare (Clark, 2001). The EMMF emphasized aholistic method of studying child health with an awareness of the “the interdependenceof the physical, mental, emotional, and environmental aspects of the life-process ratherthan consideration of any one of these as an isolated segment” (Brascombe, 1954, p. 3)Hedger was certainly in line with this method based on her written work during herassociation with the EMMF (Clark, 2001). During the 1920s, she traveled extensivelyacross the US giving lectures at universities, farmers’ institutes, and homemakers’conferences advocating her views on children’s health and other social issues (Thorne,

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2002). She published numerous articles, books, and other material during most of hercareer with a heavy emphasis on children’s health issues and parent education. Theseworks undoubtedly impacted numerous individuals and perhaps indirectly influencedmanagement practices later in her career as well. Hedger practiced internal medicineuntil 1938 and from 1912 until 1931 she had an office in the Heyworth Building indowntown Chicago (Clark, 2001). She retired from the EMMF in 1942 and moved to afarm near LaPorte, Indiana (Clark, 2001). She later relocated to Clinton, Connecticut, inthe late 1940s (Chicago Daily News, 1951).

Hedger died in Connecticut on July 10, 1951 (Chicago Daily News, 1951). Shesuffered from arteriosclerosis and Parkinson’s disease in the later portion of her life,which led to her death at the age of 83. She was never married and never gave birth toany children through her long years serving the health needs of her fellow citizens(Clark, 2001). “There are some of us who aren’t called to the big job [of motherhood]because of bad heredity” (Hedger, 1923a, p. 15). It is unknown why she chose to neverhave a family of her own. Perhaps Hedger was comforted by helping the thousands ofchildren of other people’s families as she spent her life serving them.

Hedger’s legacyAlison Comish Thorne, a celebrated Utah social activist and scholar, wrote in hermemoirs about Hedger’s impact. Early in the summer of 1923, Hedger spoke inThorne’s hometown of Corvallis, Oregon, at Oregon Agricultural College (now OregonState University) lecturing on the health habits of children. Thorne’s mother regularlyattended her speeches.

Early on, my mother had been terribly underweight and tense, and when she met Hedger forthe first time, she asked her advice. Hedger surmised that Mama needed eyeglasses and toldher to go to Portland to get a really good medical eye examination. So Mama and Papa hadgone to Portland on the train, and she secured eyeglasses that solved the problem. No wondershe attended Hedger’s lectures every chance she got (Thorne, 2002, p. 5).

Hedger is described by Thorne as being “Tall, large, but not overweight. An advocateof hygienic living, she wore men’s shoes and decried the shoes decreed by fashion forwomen’s wear” (Thorne, 2002, p. 5). In describing herself, Hedger quipped, “If I had togo on my decorative ability I would have to starve to death” (Hedger, 1923a, p. 6).Thorne considered her to be part of a first wave of feminism, but she does not believethat Hedger would have used the term to describe herself (Thorne, 2002).

Of particular interest are the prescriptions for living that Hedger espoused to otherwomen. In December, 1923, she gave an informal talk to a group of women in Pullman,Washington, at the State College of Washington (now Washington State University).During this speech, she outlined her philosophies about how women could besuccessful in the workplace.

If there is any reason I feel the importance of making good on the job it is because I have fallendown on so many of them . . . it is especially serious for the woman not to make good, becausewe are living in a serious time. Formerly there was only one job for a woman, the one big jobof marriage. Now . . . there is nothing we want to do which we cannot do (Hedger, 1923a,pp. 1-2).

Hedger went on to express her views that a woman should earn a living so she couldselect her own husband without having to settle for a poor option. When finding a

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vocation, she advised that if a woman seeks a job where she must compete with men“you have to do the job better than men and for less money. We women have to do ourwork better than men and get less for it. Someday this situation will be rectified, but weare too new on the job to try it now” (Hedger, 1923a, p. 3). This statement was clearlyprescient. Not surprisingly, she went on to emphasize good health practices forworking women which is a prescription that we can all live by today.

ConclusionThe life of Caroline Hedger was one of extreme compassion. Her writing demonstratesher desire for the people that she worked with to improve themselves by healthy livingand being contributing members of American society. Her emphasis on good health forworkers and their families cannot be understated and is an often overlooked aspect ofmanagement history. Hedger had many strong beliefs about the value of humanity andurged the people she interacted with to achieve positive health by not only curingdisease, but finding ways to prevent it. Her attempts to reduce worker fatigue andpromotion of positive health are reminiscent of modern discussions of work-lifebalance. She believed that industry must be responsible for improving and maintainingthe health of its workers; ideas which were a precursor to Corporate SocialResponsibility issues. Her work in the Packingtown neighborhood of the Chicagostockyards exemplified her life work of helping other people and seeking proactivesolutions to the social problems of her times. The owners of the meatpacking plantsinstituted harsh working conditions in their efforts to maximize efficiency and profitsmirroring some aspects of Taylor’s thoughts on Scientific Management; however,Hedger worked to encourage other aspects of Taylor’s philosophies such as cordialrelations between workers and employers by vocalizing the need for compassionatetreatment of employees and their families specifically through their improved health.Her role in exposing the living and working conditions of the people of the stockyardsdistrict was vital in helping others to see the challenges that these people endured. Hersupport of labor union activity through her affiliation with the Women’s Trade UnionLeague of Chicago was just one of the many ways she promoted social changethroughout her life by attempting to enhance worker health. These efforts stronglyrelate to the evolution of management history over time. Her career with the ElizabethMcCormick Memorial Fund traveling throughout the country as a lecturer encouragingothers to improve the lives of children, helping parents to do a better job with theirfamilies, and finding ways to bring immigrants into the mainstream of American sociallife impacted uncounted people. In many ways, her efforts mirrored those of otherreformers of her age such as Nell Nelson and Jane Addams (Nobelprize.org, 2012;Liguori, 2012); however, her emphasis on health makes her contribution unique andprovides a different perspective from which to view the evolution of managementhistory. Healthy workers supported by healthy families would impact industry in avital way. Hedger was able to influence public thought on this issue by expressing herideas to others and exposing poor management practices that fostered unhealthyworking conditions.

Hedger’s emphasis on the human being helped to expose the harshness of the livingand working conditions faced by laborers of Packingtown on a daily basis. Theimportance of the human element at this period of time had often been ignored by theadvocates of industrialization and the unending desire by manufacturers to maximize

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profits. Her work helped to draw attention to this issue and contributed to the eventualimprovement of the living and working conditions that were present for the people ofChicago. Eventually, labor organizations would help to standardize safety practices,increase wages and beneficially impact the lives of both the workers of Packingtownand their families (Horowitz, 1997). Dr Caroline Hedger can be remembered as animportant member of American history for her impact on both the residents ofPackingtown and the nation as a whole through her efforts to educate and informacross her lifespan. Her contribution to management history through an emphasis onthe health of workers and their families is unique.

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Further reading

Chicago Daily Journal (1910), “Notable men of Chicago and their city”, Chicago Daily Journal,Chicago, IL.

Hedger, C. (1923b), “Medical inspection in the school: its technique and its results”, Proceedings ofthe National Conference of Social Work, Vol. 50, pp. 374-378.

Jaques, W.K. (1906), “A picture of meat inspection”, The World’s Work, Vol. 12, pp. 7491-7506.

Library of Congress Prints and Photographs Online Catalog (1906), Chicago - Meat PackingIndustry: Dressing Beef, Slaughtering Floor, Swift & Co.’s Packing House, available at:www.loc.gov/pictures/item/2006679959/ (accessed 2 February 2012).

McKee, T.H. (1906), “The failure of government inspection”, The World’s Work, Vol. 12,pp. 7510-7514.

About the authorsBenjamin D. McLarty is currently pursuing his PhD in Management at Louisiana StateUniversity. His research interests include organizational behavior, management history, andresearch methods. Benjamin D. McLarty is the corresponding author and can be contacted at:bmclar1@lsu.edu

Peter A. Rosen is an Associate Professor of Management Information Systems at theUniversity of Evansville, where he researches on social media, technology acceptance, and usesof technology in the classroom.

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