Doctors in Business - Set 2

Business Impacts of Medical Decisions

 

Context:

On January 20th, 1914, the chief of medical staff at Calumet and Hecla, Dr. Albert Simonson, wrote to his general manager, James MacNaughton. He needed to know how to classify a hernia: injury or sickness? This mattered because the company was legally responsible for injuries but not unrelated sicknesses. A mistake here could cost them money, either in medical fees or a lawsuit if a worker sued after they refused to pay medical fees. In Dr. Simonson’s letter, he brought up railroad company rulings on the issue, showing he had done research.

The following is MacNaughton’s reply. What did he think of the question? Did he contradict himself at any points?

 

Classifications: Injury or Sickness?

 

2nd V.P. and Gen.Mgr. To A. B. Simonson, January 22, 1914, Calumet and Hecla Mining Companies Collection, MS-002, box 47, folder 520, Michigan Tech Archives & Copper Country Historical Collections, Houghton, MI.

 

Document text transcript

January 22 1914
Dr. A. B. Simonson,
Calumet and Hecla Hospital.

Dear Sir:-

I have yours of January 20th enclosing a [words crossed out] covering professional opinions on hernia, and note your request that you have a definite decision as to the policy of Calumet and Hecla Mining Company on the question of hernia. If you have given the matter any consideration at all you must realize that a decision from me would be presumptious. It is not for me or any other layman to say whether hernia is sickness or injury. If a predisposition to hernia exists and an accident brings on the hernia, the result of course is due to the accident. If a predisposition to hernia exists and the hernia comes on gradually without any attendant accident it would seem to me a doctor would classify it as sickness. Each individual case has got to be determined upon its merits and the attendant conditions. Let us assume for instance that a painter has a predisposition to hernia, i.e., he has the weakness spoken of in the article in question; he is working on a ladder, the ladder breaks and he falls, he strains himself and a hernia is the result; of course the hernia then was the result of the accident and would be so looked upon by anyone of intelligence. I might cite any number of such cases. If a man comes into the hospital with a hernia and says it was the result of an accident and described the accident, he should be turned over to Dr. Todd at once. Indeed if

 

Classifications: Injury or Sickness? page 2

 

2nd V.P. and Gen.Mgr. To A. B. Simonson, January 22, 1914, Calumet and Hecla Mining Companies Collection, MS-002, box 47, folder 520, Michigan Tech Archives & Copper Country Historical Collections, Houghton, MI. Page 2

 

Document text transcript

1/22/14
A.B.S.   #2

there is any doubt in the mind of the physician and even if the man cannot describe a well defined accident, it strikes me he should be turned over to Dr. Todd anyhow as in 99 cases out of a 100 the patient will undoubtedly claim accident of some kind. Imagine a patient applying to the Industrial Accident Board for compensation which we had denied him because I ruled that hernia should be considered sickness rather than injury. What do you suppose the Industrial Accident Board would say to me? Such a suggestion is preposterous. I can very well see the reason for railroad companies, with the low order of labor they use in many instances, making such a ruling. If you will look into the matter further you will probably find it is the Chief Surgeon of the Railroad Company that made the ruling and not the General Manager. Furthermore the railroad companies employ a great many of the men without any physical examination. A man with a hernia can get a job as easily as a man without a hernia. If he wants to be operated at the expense of the railroad company, a man with a hernia would naturally apply there for work and if any railroad company has taken such a stand it was in order to protect itself from suits for injuries that did not occur while the plaintiff was in the railroad company's employ.

Yours truly,
2nd V.P. and Gen.Mgr.

 

Context continued:

Dr. Simonson seemingly could not win. If he made the wrong decision and cost the company money, he would be in trouble. Since he asked, he got this acidic reply.

MacNaughton implied through frustrated comments about railroad company surgeons and “anyone of intelligence” that Dr. Simonson should make the classification with his medical knowledge. At the same time, MacNaughton gave an example of the company being sued after ruling that hernias were sicknesses—the exact reason Dr. Simonson wanted his approval in the first place. Because company doctors had to keep the business’s needs in mind, they preferred to let others make legal decisions, but MacNaughton answered as if this was a medical question.

Now, take a look at this letter MacNaughton sent on the 21st, after receiving Dr. Simonson’s question but before his response on the 22nd.

 

MacNaughton's Letter to Claim Agent

 

James MacNaughton To O.F. Bailey, January 21, 1914, Calumet and Hecla Mining Companies Collection, MS-002, box 47, folder 520, Michigan Tech Archives & Copper Country Historical Collections, Houghton, MI.

 

Document text transcript

Calumet & Hecla Mining Company
General Office
Jas. MacNaughton, 2nd V.P. and Gen. Mgr.
John Knox, JR., General Superintendent
Fred S. Eaton, Chief Clerk
E.D. Johnson, Purchasing Agent

Calumet Michigan. January 21 1914

O.F. Bailey, Esq.,
Claim Agent.

Dear Sir:-

I enclose herewith a letter from Dr. Simonson which explains itself. I do not know how other employers of labor classify hernia. Would it not be worth while to look it up? In any event please give me your impressions as to how hernia should be classified - whether as an injury ot sickness.

Yours truly,
Jas MacNaughton
2nd V.P. and Gen. Mgr.

 

Stop and Reflect:

• What did MacNaughton think of the question about the worker's medical condition?

• Did he contradict himself at any points?

 

Historian's Perspective:

This letter makes it seem like MacNaughton knew the question about hernias was legal, not medical. He wrote to their claim agent asking the same. Bailey’s response is not in the archives, so it is difficult to know what he said or how quickly he responded, but for an unknown reason, MacNaughton only waited one more day before sending an annoyed answer to Dr. Simonson.

Was there a discussion in the middle that we can’t find? Did Dr. Simonson and MacNaughton have a difficult relationship? Was MacNaughton simply having a bad day? Unfortunately, the archives cannot always answer researchers’ questions about people’s feelings or personal relationships.

One thing these letters do reveal is how companies felt about their obligation to employees. MacNaughton’s concern in covering hernias as injuries was to avoid workers going to the Industrial Accidents board, which helped workers or their families claim payments for injuries or death. The way they classified different ailments was not based on medical reasoning, but on what benefited the company.

 

More Documents to Explore

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  Read through a series of letters between mining company managers and doctors regarding employee requests.

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  Contagious Disease at Calumet and Hecla

  The Calumet and Hecla mining company kept monthly reports called Sanitation Bulletins as early as 1897.

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  Quincy Mining Company and Paternalism

  The practice of paternalism sometimes resulted in managers making certain medical choices instead of trained medical staff.

 

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