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In the course of research for the biography of my great-grandfather, I often travel down trainintriguing side roads which lead to new vistas of knowledge. Much of this knowledge will never find its way into the book. That’s why I like to share it here in the hope that readers of this blog will find it as interesting as I have.

This side road originated with a brief mention of Dr. Blaine receiving an appointment as surgeon for the B. & O. Railroad after he moved to Chicago Junction, OH in 1905. By that time the B. & O. had rail lines connecting Chicago, IL to Baltimore, MD, with Chicago Junction serving as a division point.

That little piece of information piqued my interest. Was the practice of hiring surgeons limited to the B. & O., or was it a common practice among all the rail lines? Hopping on the Internet, I went on a most fascinating ride, which ended at this website: http://www.railwaysurgery.org. The following information is taken from an article in that website titled “The Train Doctors: A Brief History of Railway Surgeons,” by Robert S. Gillespie.

Did you know that the railroads were some of the first enterprises, along with mining, lumber, and steel, to offer medical care as an employee benefit? Especially with the expansion of the railroads across the continent, injuries to railroad workers could occur in desolate places, far from any medical facility. Consequently, “by the early 20th century, every major railroad listed full-time doctors on its payroll.” Now Dr. Blaine might not have been a full-time employee, but he was still expected to be on call at all times to treat injured workers or even injured passengers or bystanders in the area around Chicago Junction.

To pay for this medical treatment, the railroads charged the workers a fixed amount in the form of payroll deductions and funded the rest themselves. These mandatory payments were unpopular at first and caused some unrest among the workers, but in time the benefits became more obvious and therefore the payments more acceptable. This practice of payroll deductions for medical care continues today for most employees.

Other innovations by the railroads ended up becoming accepted practice. In order to provide safer care for injured workers in remote areas, the railway surgeons developed emergency packs which were carried in the railroad cars and contained medicines and sterile dressings. These were the forerunners of our ubiquitous first aid kits.

Railroads also established their own hospitals in areas where there were no other medical facilities. Some of these became independent foundations called Employee Hospital Associations (EHAs) and gave employees more say in the management of the hospitals. In order to keep costs down, regulations put limits on what medications would be available to patients and what conditions would be treated. These strict limits and centralized approval process were radical ideas at  the time but became the basis for our modern managed care systems.

Other innovations by the railroads included the appointment of women to high positions such as division or chief surgeon. And the railway surgeons not only cared for the injured, they also “advised railroad officials on workplace safety and sanitation issues,” thus providing the foundation for what has become the specialty of occupational medicine.

So even though the last railway hospital closed many years ago and railway surgery is a specialty of the past, their innovations created out of necessity in the age of the railroad remain a vital part of our 21st century medical landscape.