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Early on the morning of May 12, 1871, a westbound Erie freight headed for Buffalo, New York, broke in two. The rear of the train, to which was attached an immigrant car, came to a stop just outside the Griswald station, near Attica. It was struck almost immediately by a following freight, demolishing the immigrant car. Six of the passengers were killed and thirty- five injured. One was badly scalded, three had fractures of the leg, and another fractures of both legs. There were also several broken arms and one fractured clavicle. Eight physicians soon appeared; the injured that could be transported safely were moved to Buffalo General Hospital. The most severely injured were removed to a recently vacated local house where one, a boy of fifteen with a compound comminuted fracture, had his leg amputated . All recovered, and the boy’s father waived his right to sue for a payment of $5,000.1 What distinguishes this sad story from thousands of similar tragedies is that we know the medical attention that the injured received. Therein lies its interest, for in the years following the Civil War, American railroads and their unions pioneered in the development of complex medical and beneficial organizations to care for workers, passengers, and others injured by the new technology. These innovations occurred a generation before manufacturing companies showed serious interest in such matters, and involved imaginative efforts to deliver emergency and preventive medi6 CopingwiththeCasualties Companies,Workers,andInjuries,1850–1900 The higher the order of railway surgery, the greater the protection to the employee, the passenger, and the company. —Motto, American Academy of Railway Surgeons The justification for the relief department must be that it pays . . . That it does pay we know from the figures. —Charles Elliott Perkins, President, Chicago, Burlington & Quincy Railroad 155 156 DeathRodetheRails cine as well as income security to large numbers of working-class men and women. Railroad workers also responded to these dangers, primarily through the brotherhood beneficial societies that provided income security against injury or death. Collectively these suggest a significant and neglected private-sector response to the dangers of industrialization. Yet it is wrong to see these organizational innovations as entirely induced by accident costs. Companies also hoped they would increase worker loyalty and reduce turnover while both employers and unions viewed them as weapons in the struggle over organization.2 TheOriginsofRailwayMedicalOrganizations As previous chapters have demonstrated, railroads began generating casualties from the beginning, and they also started to devise methods to cope with the injured and dying. The details of the first arrangement between a railroad and a physician to care for those injured in accidents are obscure. The Baltimore & Ohio (B&O) may have employed a surgeon as early as 1834. In 1849, as soon as the Erie Railroad came through the Delaware Valley, there was a “railroad doctor” who cared for the inevitable casualties . In the late 1850s, the Chicago & Galena Union, the Illinois Central , the Chicago & Milwaukee, Michigan Central, Michigan Southern, and Lehigh Valley all had some form of surgical service. In 1858, President J. Edgar Thompson appointed Dr. John Lowman the first surgeon of the PennsylvaniaRailroad.Perhapstheideaforacompanysurgeonwasinspired by a naval example, for like naval vessels that carried a ship’s surgeon, early railroading was dangerous, while many of these early lines went through wild and sparsely settled regions as far from doctors as ships were from seaports. But economic circumstances also suggest that some arrangement between railroads and local doctors must have been common. Physicians gained a predictable clientele while most carriers found it expeditious to take care of those injured in the course of business almost irrespective of legal liability. As noted, proper medical care was not only humanitarian, it lessened the likelihood of expensive lawsuits and ensured goodwill among both passengers and workers.3 Some of these early arrangements between railroads and physicians were remarkably informal. As late as the 1870s, the Philadelphia & Reading apparently had no formal contracts with physicians to care for those injured in accidents. Rather, physicians simply sent in bills for their services, which General Superintendent J. E. Wooten honored as he saw fit. Such a system presented obvious difficulties. First, as the carriers grew in size, the number of claims grew to flood proportions and it was clearly inef- ficient to have each one scrutinized by top management. Moreover, review by nonspecialists also tempted doctors to bilk the company; yet physicians risked having the fees for their services disallowed. The Reading’s records reveal...

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