Railway surgery

The duties of railway surgeons in Europe mostly involved investigations into accidents and the resulting claims arising from passengers.

The growth of other industries and improving rail safety meant that the railways no longer stood out as a leading cause of injuries.

[14] A similar picture of low rates pertained in other European countries such as France, Prussia, Belgium and Germany.

For instance, in 1880 the Baltimore and Ohio Railroad reported 184 crushed limbs, including 85 fractures and fifteen amputations.

While traumatic injuries were not the most frequent ailment they had to deal with (that was infectious diseases) it did distinguish them from typical general practitioners.

[17] First aid kits and training were introduced at the instigation of Charles Dickson of the Canadian St. John Ambulance Association and backed by many railway surgeons.

There was some opposition to first aid through fear that it eroded the professional status of doctors and that local contract railway surgeons would lose the fees they would otherwise have accrued for the work.

[21] An important function of railway surgeons was to control the costs of claims against their companies, leading to conflicts of interest regarding treatment of their patients.

[25] In this condition, the patient reports cerebral symptoms such as headache or loss of memory, but there is no visible damage to the spine.

Others, such as Herbert W. Page (surgeon to the London and North Western Railway), argued that it was psychological, or else, like Arthur Dean Bevan (1918 president of the American Medical Association), outright faked.

[27] In Britain, a number of major train crashes led to parliament passing an act which compelled rail companies to pay compensation to victims of accidents.

Colour blindness tests were introduced for all employees in most US railway companies in the 1880s because of the need for correct signal recognition.

They did this with a program that included suppressing mosquito populations, preventative quinine treatment, education, and blood tests.

Early American railroads passed through vast, thinly populated regions with little possibility of finding local medical care.

That, together with difficulty in retaining skilled staff and the risk of legal action by injured passengers resulted in American railway companies developing medical infrastructure and organisations to a degree that was not seen elsewhere.

With their higher population densities and shorter routes, European countries carried more freight per mile of track than in the US.

In Australia and Canada railway surgeons were appointed during the construction of major lines in remote regions.

[39] India is perhaps the closest to the US in widespread use of railway surgeons which continues to this day, but there they never seem to have organised themselves as a discipline with professional associations until the 2000s.

From 1850 until World War I, American railroad companies developed their own medical arrangements in order to retain workers, care for their passengers and injured third parties, and avoid legal action.

The AMA also disliked the practice of doctors bidding for local contracts with the railway companies as this also introduced commercial pressures.

It lost its political influence in the 1930s during the Great Depression as industry, including the railroads, reduced their involvement in health care for their workers.

[56] The first dedicated accident and emergency (A&E) service in Britain was associated with the building of the Manchester Ship Canal, 1887–1894, rather than railways.

However, the civil engineer in charge, Thomas A. Walker, had a background in railway construction around the world, particularly in Canada where he had experience of employing British navvies.

In the US, a hospital car came into use on several railways that could be coupled to a train to transport the surgeon and staff to the scene of an incident along with all the required equipment.

The Pennsylvania Railroad organisation was the prime mover in forming the National Association of Railway Surgeons (NARS) in 1888.

[69] However, NARS was short-lived, dying out in the 1920s as industrial expansion caused the railways to no longer be unique in their medical needs.

The editor, R. Harvey Reed, was a charter member of NARS but left to form the more exclusive American Academy of Railway Surgeons.

The two organisations remained rivals until 1904 when they merged to form the American Association of Railway Surgeons (AARS).

So much effort was devoted to discrediting the condition as medically valid that one writer claimed the issue was the reason for existence of the association.

Prominent in NARS for speaking out against Erichsen was Warren Bell Outten, chief surgeon for the Missouri Pacific Railway.