More history: railway surgeons

The article is a couple of years old, but Beachcomber recently linked to it.   I didn't know that the advent of the railways, and the injuries railway workers suffered, led to the speciality of the railway surgeon:

For rail workers and passengers of the 19th and early 20th centuries, train travel — while miraculous for the speed with which it carried people across vast distances — presented ghastly dangers. Brakemen commonly lost hands and fingers in the hazardous coupling of cars. Exploding boilers released high-pressure steam that scalded stokers. Passengers were maimed or crushed when trains jumped the tracks, or telescoped into tangles of wreckage. And in the hours they spent aboard, travelers and workers suffered heart attacks, strokes, seizures, all the health hazards of daily life, but far from their family doctor — or sometimes any doctor. One in every 28 railroad employees was injured on the job in 1900 — and 1 in 399 died.

These grim statistics helped spark the development of a new medical specialty during the Victorian Era: railway surgery. Physicians in this field focused on the injuries and maladies specific to workers and passengers. Eventually, railroad companies would open hospitals close to the tracks in remote locales otherwise without medical facilities. Professional organizations arose that furthered railway-related medical knowledge and investigated new avenues of preventive medicine. And within a century, railway surgery met its own untimely end — but its influence continues today....

... at their peak, about 35 railway hospitals had opened in the U.S. These included the Southern Pacific’s 450-bed hospital in San Francisco, the second medical facility in the country to operate an intensive care unit — a specialized approach to treatment much needed by maimed railroaders. Other rail systems contributed to existing hospitals on their routes, or set up mutual benefit associations for workers that covered the treatment of injuries. This was long before other industries considered providing health care services to employees.

So expansive were these railway medical systems that in 1896, just one railroad, the Missouri Pacific, treated more than 29,000 patients in its medical system and clinics, comparable to major metropolitan hospitals. “The direct descendants are employer-based insurance and employer-based health care,” says Stanton. “A lot of the larger corporations still do that. They have a medical center and a medical staff inside the factory that does the initial evaluation before getting patients out to the emergency room or hospital. What’s come out of railway surgery is our current employee-based occupational health system.”