A Lasting Legacy
Despite the suspicions against them, railway surgeons helped pioneer many methods of examination and treatment now commonplace in occupational and emergency medicine. They reported in the medical literature on a wide range of traumatic injuries, from broken limbs to ruptured organs to trauma-induced deafness, plus the treatment of typhoid and other serious diseases of the era.
Railway surgeons also performed preventive vaccinations on workers at risk of contracting malaria, smallpox and typhoid. They advocated for cleaner, better-ventilated cars supplied with pure drinking water and free of clearly sick people. (One went on record to complain of a passenger with tuberculosis who wiped his mouth with the window drapes of a coach.)
In addition, these were among the first physicians to make workplaces safer by administering pre-employment physical exams and testing worker vision and hearing. Railway surgeons broke ground in the diagnosis of colorblindness, a cause of fatal accidents when impaired workers failed to correctly see colored signals and lights. These doctors assembled care packs for use in the field, jammed with supplies and dressings, presaging the modern first-aid kit, and some railway surgeons trained workers in common first-aid techniques.
Compared with most people in the U.S. at the time, railroad employees had superior medical care and more doctor attention, including access to a variety of specialists.
Railway surgeons had become so essential in America’s health care system that by World War I, they accounted for 10 percent of the country’s physicians and provided care for 2 million rail employees. Yet circumstances would push their medical specialty into obscurity and irrelevance within a few years of the war’s end.
By the 1920s, many small towns and remote areas had their own hospitals, ending the need for specialized railway medical clinics. Increasingly covered by private medical insurance, workers and passengers insisted on seeing doctors of their own choosing. Eventually the salaries of the doctors and staff, and the upkeep of specialized hospitals, burdened a rail industry already beleaguered by competition from automobiles, trucking and airplanes.
A few of the railway hospitals remain standing, many of them repurposed as facilities in today’s health care systems. The Frisco Railroad’s hospital in St. Louis now operates as a nursing home, and the Southern Pacific’s hospital in Houston currently serves as an HIV/AIDS clinic in the Harris Health System. Even more lasting, though, has been railway medicine’s mark upon contemporary health care. It’s unlikely that any of us today would think of railway surgeons when reaching for a first-aid kit, taking a vision or hearing test or submitting to a vaccine.
“In this era, physicians were the handymen of health care. They did a little of everything,” Stanton says. “Whether we know it or not, the railroad physician lives on in providers who gain extra knowledge and skills to work with a particular high- or unique-risk occupational population.”
The train may have passed, but the whistle still echoes.
[This article originally appeared in print as "Doctors Derailed."]