>~*&£ ^% 3sV :> J^ 3nV5 -> ^1 .-% > ^ >>> . jo >:> . x> >> > » ^ ^ ■& - - ^.-«. > i ^ > ? <- > * - -> > > .- > > > ■»■ > ^ > > -5 >> >• > » y T> >-)-» "V-X8 s~ JL' *-^> tkSAl4iS> K" Surgeon General's Office AWJffBX *•!?<■ No.//1^ ^ ^gOgQQff QQu;C aj Q^.^-»^ •/ 1 712975 It >- O /%,----<>'. ion. In this case, the shock to the system was very severe but could hardly have been greater than in the one I shall presently contrast with it; and"the actual injuries were far less in amount. Now, had the sufferer been gently removed to the nearest town or flag station, and her necessities promptly attended to, instead of time being lost, in carrying her on from place to' place, a downward impetus being thereby given to already depressed and rapidly failing vital powers, might not the result have been different, and not only a valued life saved, but liabi- lity on the part of the company to the highest amount of indi- vidual damages avoided ? • By way of contrast let us take the following case: In Octo- ber, 1857, a boy, eleven years of age, jumped out of the bag- gage car of an express train, at full speed against the rocks m a cutting, and, rebounding on the track, was picked up, horri- bly mangled. His injuries were as follows : The left foot and leg, from midway below the knee, completely smashed and in part torn away, fracture of the right thigh, compound fracture of the right leg midway below knee, both bones protrudino- compound fracture of the right great toe, and a severe -caB wound of about three inches in length. When we add the fear- ful violence to the general system necessary to cause such a mass ol injuries the case might well seem hopeless. He was quickly 15 removed to his parents1 residence, and medical assistance promptly at hand. I had the satisfaction of discharging him sound, of course with exception of loss of one leg below knee, after four months' attendance. There cannot be a doubt that had this boy been carried, in the usual way, twenty miles, to a distant hospital, he would have been added to the list of railway victims, and his death regarded as a matter of course, instead of growing into a fine, intelligent lad, and, supplied with a Palmer's patent leg, being' actually employed, not long since, as runner, by the New York agent of that valuable apparatus. In this case everything favured prompt attendance. The train was little more than a mile from the station, and at the moment of the accident another was coming up in the opposite direc- tion which brought him back ; carriages were in waiting for this due train, in one of which he was immediately removed home; another surgeon and myself were on the spot almost as soon as he arrived there, and, desperate as the case appeared to be, the saving of time proved to be the means of saving life. In February, 1854, messengers came to the village, between 3 and 4 a.m., stating that the bridge at the creek had broken through, that a car-load of passengers was submerged, and medi- cal assistance needed. It was a bitter cold dark morning. I hastily gathered all that I thought might be useful, and, after several times narrowly escaping a capsize in snow-banks, reached the spot. Matters were not so bad as had been represented. One engine had got safely across; the second, for there were two, had gone down with the express baggage car, in deep water, and the passenger car rested on the top of the latter, hanging half-way over the end of a broken track, thus allowing the few passengers to escape. Two scalded firemen had already been attended to. I made inquiries whether any others were hurt, but could learn nothing satisfactory, the employees seeming to regard me rather as an interloper than in any other light; I consequently started tor the scene of the accident on the New York side. It was still dark, and on reaching the drawbridge, where the rail was laid along single timbers, which afforded the only means of crossing, these were so covered with ice that, after a few steps, I found it impossible to get over without the greatest risk of being blown off on to masses of ice below, so I turned and went home. I subsequently learned that I had been within a hundred feet of the express messenger, who would not leave his charge, and was suffering intensely from a sprained ankle, and for whose relief I might have done much, while assistance did not arrive from the city for several hours after- wards. Lucky was it for him that his injuries were no worse. One more case and I have done with this part of my subject. 16 Some two years since a man threw himself down under an empty passenger car on the off track and went to sleep. Mean- time the train came along, backed up and took off the empty car, wliich went over both the legs of the sleeper, who had not been observed. Here was a case at a station. I shortly after arrived and found him lying on the floor of one of the waiting rooms in the midst of a large crowd, with both legs fearfully crushed and bleeding profusely. What was to be done now was the question. Nobodj' would take him in, for he was but a poor loafer, and certainly nothing could be done where he was; the only alternative therefore was to staunch the bleed- ing, and as a train was soon coming up, he was bundled up in the best way circumstances permitted, and so sent as usual in the baggage car to the City Hospital with a result easily fore- seen. His chances of life were perhaps but small, but even that little was denied him, and he died almost as soon as he arrived. . These cases, wliich might be multiplied adinfinihwn, those occurring in one place being only repetitions of what takes place in another, go far to prove that none of our present insti- tutions are sufficient to meet the peculiar wants of the injuries under consideration; that as many sink from shock and* from the length of time that elapses before they are subjected to treatment, half an hour or an hour often determining'the ques- tion of lile or death, it becomes the imperative duty ot the rail- road companies, as well as their interest from the great pecu- niary loss.es they are subjected to, to make some special provision adapted at least to relieve the immediate pressing necessities of tho>e who may be injured on their lines, and thus place them in a condition for future successful treatment. Having arrived thus far, I think it is made sufficiently appa- rent that the present state of things involves injustice to the public as travellers, who are all equally liable to injury • injus- tice to the public again as stockholders, by the amounts wasted m litigation or damages for real or spurious injuries, and in this the widow and orphan, whose little means are invested are as much interested as the merchant and capitalist; i. justice to the injured, who cry in vain for help when it is most needed ■ and, finally, injustice to our profession, whose members have too often 10 give their time, labor, and skill, gratuitously and I may here observe, that in all cases of this class I have had to do with, 1 have but in one received any remuneration WP may not ignore the claims of humanity, nor do we wish to- but to that public, on whom after all the.great burden of the wron» falls, I say: do also your part in satisfying those claims' strengthen our hands, give us needful appliances and conve- 17 niences, thus enabling us to use whatever skill we may possess to the best effect, and while we shall still gain little pecuniarily, you will be gainers in every way, you will mainly reap all the benefits. Assuming the necessity for medical provision for railroads as established, I shall now proceed to develop practical plans for the accomplishment of this object. It is clear that the appoint- ment of a surgeon, or a corps of them, at the main termini wTould not avail, nor would it answer to appoint paid surgeons on the line, who might never be employed. It must be borne steadily in mind, that our object is not to make permanent pro- vision for the injured, though it may be used as such when desired, but merely to bridge over that fearful and fatal gap which intervenes between the time of the infliction of the injury, and that when the sufferer can be handed over to the surgeon of his own choice ; thereby affording to the latter as good a chance of curing his patient as though he had taken possession of him from the first moment. To meet on the one hand the requirements of the ca«e without infringing on the just rights of companies on the other, the provision must be sui generis. An accident may be recorded in one locality this week, the next may occur a hundred miles away, yet the same provi- sion should extend equally to both without subjecting the respective companies to unnecessary expense. Such is the problem to be solved. I propose to consider the question under two heads : first, by arrangements along the line ; secondly, by arrangements in the cars, by one or other of which, or by com- binations of both, we can effectually secure the desired end on every railroad in existence. First, then, as to arrangements along the line: and here I shall again avail myself of what I have previously written. Let each company appoint at its main terminus a medical inspec- tor, with the rank of assistant superintendent. The duties of this officer would be to organize the line into districts ; to issue medical regulations, with sanction of the general superin- tendent, to whom he would be subordinate; to receive and to collate reports; and to act as medical adviser of the Board of Directors in all pecuniary and other transactions with their dis- trict surgeons, to be presently mentioned. His duties would be of a confidential character, and he should be entirely in the interests of the company. His functions being multifarious, he should be a salaried officer; but as his duties would not inter- fere very materially with the requirements of private practice, his salary need not be a large one. Now, where an accident occurs, every railway servant is willing to assist, and does the best he can—often, however, acting very injudiciously for want 18 of knowing better: one of the first duties, therefore, of the inspector, after organizing his department, should be to issue a simple code of directions to station-masters and flagmen, instruct- ing them what to do previous to the arrival of a medical man in cases of accident. For instance, if a person is bleeding from a wound, the employees should be directed and shown how to apply a pad and bandage ; and so a man may be saved from bleeding to death. If the sufferer is pale and chilly, with cold extremities, the railway official should be instructed to make a bed on his stretcher, to heat a brick and put it to the feet, also to administer a little warm tea at intervals, thereby often sav- ing a man from sinking to death ; and when a medical man arrives, instead of having to abandon the patient as a hopeless case, reaction may be commencing, affording encouragement to bestow his most strenuous efforts, or the powers of life may be so far restored that he can decide and act upon the neces- sary treatment at once. So much for the duties of the inspector. In the next place, let the companies appoint district surgeons, unsalaried, but payable for actual services rendered, at the prin- cipal towns along the line, and not exceeding from ten to fifteen miles apart—the district of each to extend to the flag station nearest to midway between any two. The principal advantage attending such regular appointments would be that, where medical assUance was not immediately at hand, the employees would know exactly where to send for a competent practitioner. At each such surgical station, a small room should be set apart on the ground floor, furnished with an iron cot bedstead and bedding, a stretcher with mattress and pillow, a small table, one or two common chairs, and a small wood-stove, by which, if required, the room could be heated in a few minute's in winter or hot water or a brick for application to the feet any time' 1 may here observe, that if the companies did their part, I have no doubt each surgeon could raise among his own friends and patients not only enough to furnish the main station, but also to provide every flag station, with a stretcher and mattress to be kept_ahvav8 ready for use. The surgeon might also keen at the station a little linen, lint, bandages, sponges, a few splints and such minor articles for immediate use. He should also make it a rue to carry a tourniquet. In case of an accident a stretcher and bed could be obtained from the nearest flao- 8ta tion, or those from the adjoining ones if several were seriously hurt, and the medical officer summoned, also those of adjoining stat.ons, if necessary, as well as any competent medical men in the vicinity. It any injury were too severe to risk removal the patient could be carried to the nearest flag station until the immediate danger had subsided; where practicable, however 19 he should be carried to the district station, his immediate wants there attended to, and provision made for safe removal. When a surgeon is summoned to the scene of an accident, he should have the right to avail himself of any passing train, that as lit- tle time as possible might be lost; and it should be his duty to examine carefully into the amount of injuries sustained, and to keep notes of the same for future refreshment of his memory; also to furnish a copy to the inspector, to be kept on file at the chief office. In cases of fraudulent or exaggerated claims upon companies, their medical officers would become most important witnesses; and I believe the amount thus saved_ would far exceed all costs, and tend greatly to diminishlitigation. By such arrangements if a person were injured severely on the line, passenger or otherwise, he would be laid on a comfort- able mattress, his limbs arranged in the position affording most comfort, and so be carried by hand on a stretcher into or out of the cars without further disturbance until he reaches his des- tination. If several were injured, messengers might be sent to the adjoining flag stations, or the engine and tender detached thither; and so, in a short time, beds would be brought to the spot, and our first great need supplied. If any medical men were at hand, they could at once render valuable assistance ; meanwhile, the district surgeon would be sent for, who, on his arrival, would take authoritative charge, and promptly and effi- ciently proceed to do whatever could be accomplished by a sur- geon of skill and judgment. System and order would work out their natural results, suffering would be diminished, and life oftener saved. With the general introduction of such a sys- tem, we should have heard the last of a railway victim, with reac- tion approaching and returning circulation, awakening, per- haps, after a twenty miles' ride, to intense suffering, with the hard floor of a baggage car for his bed, a coat rolled up for his pillow ; then having to endure the almost insufferable agony of removal, with broken limbs dangling or awkwardly handled, to a carriage; and from thence once more, with powers now for the second time prostrated, to the bed, from whence he is never destined to rise again. „ . , , j tl The above plan would be very well suited to such a road as the Hudson River Railroad, where there are flag stations at almost every mile, and where important towns are near together. Many of the lines, however, run through thinly populated dis- tricts with long distances intervening between stations and flag stations. Here, our apparatus would not be sufficiently acces- sible ; and we need, therefore, some slightly different provision. This must be furnished by appliances in the cars themselves. In many of these, there is at the end a small portion partitioned off, 20 and containing a couple of seats. Remove these, and we have all the space we want. With three or four stretchers and mat- tresses, with proper bed furniture to match, a dozen yards of ten cent muslin to make rollers, a little linen and lint, a couple of rolls of cctton batting, a yard of strapping, a few square feet of thin hard pine, a small saw to cut it up with, a stone bottle for hot water, and a tourniquet or two, which any conductor can be easily taught to apply; adding, perhaps, a little brandy, a small bottle of laudanum, and one of hartshorn—we shall have provision, such as would not only allow a conductor to perform the first requisites, but to enable a moderately efficient medical man, should there be one in the cars, which is often the case, to put up a patient in a comfortable manner until he was in a situation to be placed under permanent treatment; or, at least, in charge of a district surgeon, who might live at a consi- derable distance from the scene of the accident. For instance, suppose a brakeman, or passenger, stepping from one car to an- other, fell from the platform and sustained a severe fracture, with other injuries ; the conductor, if there were much haemor- rhage, could apply a tourniquet, place him in a comfortable position on a mattress, apply a warm water bottle to his feet, and so carry him, with little disturbance, until delivered to the surgeon who was to treat him. If a medical man happened to be in the cars, he might, in addition, pillow the limb, or use splint or bandage, or administer restoratives, or an opiate, as the circumstances of the case warranted in his judgment. In other respects, the same principles and mode of proceeding would apply as heretofore laid down. The car, containing the above requisites, should be as near to the centre of the train as pos- sible, as least liable to inj ury. One or other of the above named provisions, or both combined, would suffice to meet the wants of every railroad in existence. In the case of short lines of railroad, not exceeding twenty or thirty miles, an inspector would be unnecessary, requiring only provision in the cars, and a surgeon at either end. Where a short line is leased to a great main road, the medical arrangements of the lesser would be merged in those of the greater. Such is the ba>is I propose for a general system of medical provision for railroads. It would be out of place here to enter into the nature of the instructions and regulations that would issue from the inspector's office for the guidance of his staff further than to say that they would probably resolve themselves into two kinds: first, such as might be suggested by the super- intendent as necessary to bring the whole working arrangements of the line into harmony ; and second, advisory as relatino- to new discoveries m science, new principles of treatment, new 21 appliances, or whatever may seem calculated to promote our efficiency as practitioners. ■ An institution so extensive cannot be expected to start into existence in full perfection, though all our main ends will be secured from the commencement. After a little working of the machinery all asperities will be smoothed down, and a system as perfect and beautiful in all its parts as combined talent and skill can make it will soon result. A word with regard to our profession. We shall here have a great number of intelligent professional minds enlisted and immediately interested in the work. From such many excel- lent practical suggestions will emanate, which, gradually embo- died into rules and regulations within the capacity of employees, will tend to perfect the general system and increase its efficien- cy. Should the medical officers of a line come together once a year bringing reports of cases and the results of their experi- ences, accustomed as they would be to treat desperate injuries, we might look for much tending to advance general professional knowledge. AVhatever proved of eminent utility in one case would become the common property of all, and might at stated interva's be embodied in circulars, wliich would be interchanged with similar ones issued by the officers of other lines. In most neighborhoods efficient medical men will be found. There may, however, be some localities newly settled and sparsely populat- ed, where good surgeons, if any at all, are difficult to be found. In such places there are often influential men, who are selected as directors of the line which passes through them. Let these look around, select from among the more distinguished young graduates of our great medical schools competent men for their district surgeons, give them enough of the family patronage and that of their friends to enable them to live at the start, and they will gradually become the consulting surgeons of their neigh- borhood, introducing a higher standard of local professional attainment, as well as helping to elevate and ennoble our pro- fession in the minds of the people generally. A few words must suffice, as not properly belonging here, with regard to the economy to railroads generally in adopting a system of medical provision. I have already alluded to the diminution of litigation, and check to fraudulent actions, by the command, on the part of railroads, of medical witnesses, who had been enabled to examine every injured person at the time of the accident. To this must be added the diminished liability of the companies, which will be in proportion to the life-saving efficiency of the arrangements proposed. In the statements of expenses for 1860, in the State Engineer's Report, we find under the head of " Damages to Passengers," on the five railroads previously mentioned, the sum of $50,706 (I omit cents), of 22 which 833,626 were paid by a single corporation, although only nine passengers were killed' and forty-three injured ; while an- other paid only $12,366, with eighteen passengers killed and forty-three injured ; a third paid $1,241, with twenty passen- gers killed and forty-six injured; and again with a fourth, $3,223 are registered against a company with no passengers on the killed and injured list. This part of our statistics, therefore, affords no uniformity in its results, as might be expected, where two or three years may elapse on a line without any very great accident, although when one of the latter does occur, the damages may amply compensate by their amount for thesmall- ness of them in other yeais. Taking an average of the amount paid by the five alluded to previously, in 1860, it will be a lit- tle over ten thousand dollars for each. On some lines no acci- dents are recorded under any head. On sixteen lines where such have occurred, with a total length of 1,954 miles, the total amount of damages paid for injuries to passengers was $60,725, a little over $3,100 for every hundred miles of road. In other years of course the statements will vary, some paying more, some less. Some will meet with heav}7 accidents where none have heretofore occurred, and others will be comparatively free from them, which now figure heavily in the list. As with the advent of epidemics, there is no certainty about them, except that they will certainly turn up somewhere or other. Let them not find us unprepared. Of the thirteen hundred and seven persons killed and injured, and heretofore alluded to, we find that six hundred and eighty- seven belonged to the companies, either as passengers or em- ployees, while six hundred and twenty, or nearly one-half of the whole number, were persons unconnected in any way with the respective lines, and for whose injuries the companies cannot for the most part be held in any way responsible. They cannot, nevertheless, be overlooked in any humane endeavors for the relief of the injured. True, many of these are killed instantly by being run over or struck by the engine ; but still a very large number remains, and this leads to the irresistible inference, that while the companies should be compelled to do their duty in this matter, there is also a large part to be performed by the public themselves, upon whose shoulders a portion of the bur- den should justly rest. Let, therefore, the railroad managers provide their stations or surgeons, paying the latter for the first dressing, at least, in all cases, and giving to all a share in their life-saving arrangement, whether connected with the line or not. Let, on the other hand, the public establish societies on the same principles of benevolence as those for the saving of life by any other class of casualties, calling them Railroad Accident 23 Relief Societies, or by any other name they please, whose ob- ject it would be to strengthen the hands of surgeons by fur- nishing stations and flag stations with needful apparatus, such as the stretchers, bedding, and bed-furniture, splints, and those necessaries which no individual practitioner could be expected to possess in sufficient quantity to meet the requirements of a great accident. Of these the inspectors of lines might be made the distributing agents. As passengers and employees would share in the advantages offered thereby to others, the companies would thus get a fair quid pro quo. When the companies have done all in their power—and as far as judicious regulations, and careful and vigilant supervision go, 1 believe they have—to insure the safety of those who travel on their lines, and have further by proper arrangements done their best for the recovery of those who may be injured, thus making complete provision for every emergency in every department, they will have a good right to claim at the hands of their re- spective legislatures, relief by the introduction of measures of limited liability. As the laws stand at present, I believe it is sometimes cheaper to kill people outright than merely to hurt them. They should not be made to pay more for lives saved than for lives lost. To railroad managers these propositions are respectfully submitted. Let them once take into serious con- sideration the question, whether the claims of humanity and the interests of stockholders are not entirely reconcilable in this matter, and the ultimate result cannot be doubtful. To return to my legitimate sphere. I have in this paper de- voted more space to the necessity for medical provision for rail- roads, than to the details of it; for, let but the truths I have here endeavored to lay down be established in principle, the necessity for action in the matter of railroad accidents be once fairly impressed on the public mind, and we may rest assured that, based either on my plans or some better ones, a great and noble institution will ere long start into existence; the result of which will be to save as much life, to alleviate as much suf- fering, as any one of the great benevolent institutions of the day. We must not, in this or any other new and great under- taking, expect perfection at the start. There will be many practical difficulties to surmount, requiring in any one who shall be entrusted with the task of putting the scheme into practical operation, talent, energy, and entire devotion to the work before him. We should have to decide exactly before going to expense what apparatus we would employ, and, in some instances, adopt new contrivances. Abundance of surgi- cal apparatus we have; but bearing in mind that our arrange- ments are but for temporary purposes; that everything must be 24 reduced to the smallest amount of space compatible with the object to be attained, as well as to be of the most portable kind; that cheapness, too, will be an essential matter; we shall have to look forward to many new and simpler appliances than those often in use in permanently treating a case. For in- stance, the most important piece of furniture would be the hand ambulance. Now, I think it would be easy to construct a thing of this kind, which, folded up, would form a simple flat stretcher; the legs dropping from the sides, it would form a bed- stead ; and by curtain posts, that might be raised up from either end, the curtains being usually kept folded under the mattress, convertible into a covered hand arhbnlance; so that from the moment a patient was taken up and laid on the stretcher, whether he were conveyed to a station, or put into a car or carried through the streets, he would never have to be disturbed from his original recumbent position until placed under the care of the surgeon destined permanently to attend him. In this, and similar matters, with able inspectors, willing to listen to every suggestion, and capable of sifting the chaff from the wheat, and determined to adopt nothing that was not tho- roughly practical, as well as reasonably economical; with a large body of able practitioners associated directly in the work, and the general intelligence of the whole mass of the profession to guide and assist them, all obstacles, as far as our part was concerned, would be easily surmounted. I had now arrived at the concluding paragraph of my paper, when I received an important communication hearing, immediately on the subject in question. Singularly enough, while I was working out the above details, another gentle- man was preparing a great and comprehensive measure now ready to go before the legislature with the sanction and support of most of the leading Railroad Presidents, as I am informed, and of wdiich this very medical provision forms an essential feature. It is only within the last few days that either party has been aware of the proceedings of the other, yet the two measures dovetail into each other exactly, the one clearing away all financial difficulties, the other supplying a basis for the pro- posed surgical attendance. I am permitted to give an abstract of the proposed measure. [As several modifications were made in the Bill since this paper was read, and as in the next article a full abstract is given of the measure as it stands at present, I omit it here 1 In view of the fact that the question of medical provision for railroads is about to come up before the Legislature of the State in a measure thus large and comprehensive, would it not be desirable that this Society should take some action in the pre 25 mises by a petition to the Legislature setting forth that, in the opinion of this body, great suffering is entailed and much loss of life and limb incurred by the want of medical provision cal- culated to secure more speedy and efficient attendance on persons injured by railroad accidents, and praying that the legislative body will either originate some measure or take into their ear- nest consideration such as may be brought before them bearing on the subject, in order that thereby the desired object of pro- per medical provision for railroads may be ultimately secured by such legislative enactments as in their wisdom may seem proper. I am not in the habit of drawing up petitions; but by such a one, yon would, and none could do it with more propriety as representatives of the great medical body of the State, without interfering with functions not properly belonging to you, be the first to step forward as promoters and pioneers of a great and humane movement. In conclusion, when our object shall be finally attained, we have only to do our whole duty, leaving the rest in the hands of an all-wise, overruling Providence. Successful, we shall carry joy into many a household that might otherwise have been made desolate: should it be differently ordered, though we fait to save life, we shall not fail to diminish suffering; the last moments of the unfortunate sufferer will not be embittered by unnecessary torture, and what can by possibility be avoided is unnecessary; while to sorrowing and perhaps distant relatives there will be afforded the one source of consolation that all had been done by wise precautions and humane provision, as well as by practical sympathy and professional skill, that could reasonably be looked for in an enlightened and Christian com- munity. Yonkers, February 1, 1862. ACTION TAKEN BY THE NEW YORK MEDICAL SOCIETY. The following report of the Proceedings is taken from the American Medical Times. " Dr. Shrady (X. Y.), offered a preamble and resolution relative to the medical provision for railroads,, as advocated by Dr. Arnold during the morning session :— " Wlunas, In the opinion of this Society, much loss of life and limb occur from want of sufficiently speedy medical assistance in cases of rail- road accidents, and "~\Yhcre.as, The efforts of medical men, when present, are often ren- dered nuo-atorv bv the want of suitable appliances, and ° "" ' 3 26 " Whereas, It is desirable that some better provision should be made than at present exists to prevent railroad casualties, and " Whereas, The Society has been informed that a large and compre- hensive measure is about to be introduced into the Legislature of the State, of wliich proper medical attendance for railroads forms an essen- tial feature : therefore be it " Resolved, That a Committee be appointed to report at the earliest moment whether any or what action shall be taken by this Society in the premises. " The Committee consisted of Drs. G. F. Shrady, E. Arnold, and A. Willard, of Chenango." At the morning session, on the following day : " Dr. Shrady, as Chair- man of the Committee to report on medical provision for railroads, offered the following for adoption :— " Whereas, This Society has heard that a measure is about being intro- duced into the Senate, of wliich an essential feature is thorough medical provision for railroads, and " Whereas, We believe that much loss of life and limb result from want of such provisions : therefore be it " Resolved, That we hail with satisfaction the introduction of any plans calculated to secure so desirable an end, and " Resolved, That a copy of the foregoing be forwarded to Senator Smith, of Kings county, the gentleman who has given notice to the Senate of the introduction of such a measure." The foregoing Preamble and Resolutions were duly seconded and unanimously adopted. OINT MIMICAL PROVISION FOR RAILROADS. SUPPLEMENTARY PAPER: CONTAINING ALSO AN ANALYSIS OF THE BILL ENTITLED A BILL to provide Compensation to Passengers for Injuries sustained on the Railroads of the State; also to provide Surgical stations and Hospital Accommodations on the Railroads of the State. Read, before the Surgical Section of the INTew York .A-cademy of Medicine, October ^4, 1S63, By E. S. F. ARNOLD, M.D., M.R.C.S.E., RESIDENT FELLOW OF THE ACADEMY. The need of some arrangements better than those now exist- ing for the saving of life in cases of railway casualty has been so&generally admitted by medical men ; so many, both in and ouf of the profession, have not only endorsed the propriety of measures to that effect, but expressed a wonder that such had not been suggested before, that it would be a waste of time to brin^ before this body any fresh arguments to prove the neces- sity of medical provision for railroads. it will be remembered that on the 28th of February last, 1 was called upon to explain my views, of which the following may be regarded as a summary :—The attachment to our lead- in^' stations, at intervals, where practicable, of not more than ten miles, of a small room kept at all times in readiness for the reception of injured persons, and providing the same with sur- gical apparatus, carrying also appliances in the cars where the stations were too far apart to enable us to get at such appara- tus without great loss of time. The appointment of competent suro-eons to attend to the injured, unpaid, but payable for actual services rendered ; such services to extend, however, only to such a period as shall enable sufferers to be removed without risk to the care of their own medical attendant, or be other- wise safely disposed of. The District surgeon would also tnke authoritative charge in case of any great accident involving iniury to a number, seeing to it that ail were efficiently cared for to effect which he would be empowered not only to avail himself of any efficient medical assistance at hand, but also to 28 call in additional aid, if necessary. The appointment, lastly, of a general medical superintendent to supervise the working of the whole. T>y the adoption of such arrangements, with their attendant details, I claim, not only that the loss of much life and limb would be avoided, but that, in cases where thus much could not be accomplished, we should at least be enabled greatly to mitigate the sufferings of the victims of railway casualty. I claim also, as railroads are becoming the great vehicle of travel in every part of the world, and inasmuch as with the best of care and regulations, wood and iron will give out at the high rates of speed required and attained, that the proposed institu- tion, once introduced and incorporated into the railway system, could take its place by the side of the other great humanitarian life-saving institutions of the age, while, as regards expense, it would ere long be rather a source of economy, than otherwise, to adopt such measures. Cue of the medical journals (Phil. Med. cG Surg. Reporter), in a very complimentary article upon my former paper, asks, however: u whether the plan proposed is not more compli- cated than necessary, and whether the end sought could not be attained by loss machinery? whether the impromptu authoring of surgeons from the vicinity where an accident occurs, their compensation to be regulated in the same manner as that for other services rendered and to be paid by the company, would not be much more simple, prompt, and effective, and'comport better with the dignity of the profession ? Whether, if the surgical appliances ;.re kept, as thev should be, at stations and m the trams, as a part of the paraphernalia of the road, the end sought, viz. the speedy care of the wounded and muti- ated, and the speedy supply of all their necessities, could not be better accomplished without the routine of 'Head Sur- geon and 'District Surgeon,' general duties and subordinate duties. lhe paragraph just quoted may serve as a text to say a tew words on the administrative features of the proposed system, winch have been only lightly touched upon in my former paper. J -; # When a person is seriously injured by railroad casualty he is often perfectly frantic to be removed to his friends, altlmuo-h perhaps a long distance from home, and why? Partly no doubt, because he has more confidence in his own medical adv.ser than in strangers; partly, because there is a strong iutuial desire to be amongst one's own friends when life is in danger; but is this all? I think a more powerful motive still comes mto pjav, vlz. tll d d of folli| -nto ini:0m hand,. lhiS lt is that mainly induces him to wish removal to 29 a great distance when he feels that he needs quiet and rest; and if he knew of a well-appointed hospital in the neighbor- hood, I feel sure that in nine cases out of ten he would say— " Carry me there." By the establishment simply of hospital sta- tions we should make some approach to this, but without regu- larly appointed medical men we should not be much better off than before. We should have all the expense with but a small por- tion of the advantages resulting from adoption of the entire plan. Under the proposed system the railroad employees would know exactly where to look for the most competent sur- geon in any given neigborhood, which is seldom the case at present, and a general knowledge of the fact would tend greatly to add to the feeling of security on the part of travellers. Again, what could more forcibly illustrate the necessity of some one competent man taking charge in case of many being in- jured than the scene described by a distinguished member of your own body, at a former meeting of this section, when sum- moned to a great accident; where regu'ar practitioners, homoeo- paths, hydropaths, Thompsonians, and herb doctors all rushed to the spot, and whoever could first stick a piece of plaster upon one of the unfortunate victims of his attention claimed him as his patient, adding thereby only to the prevailing con- fusion, and accomplishing nothing, so that he was finally com- pelled to take the whole in charge. Would the system I have proposed be worth a straw, if every practitioner, whether regu- lar or irregular, were considered competent to carry it out in its most important particular—the affording prompt and effi- cient relief to the injured ? Is the selection of skilled members of the profession of less importance than the choice of appara- tus? How would it be with our public hospitals if every one who signs M.D. to his name were, without reference to special qualifications, considered competent and voted in or appointed as interest might dictate? Are skill and judgment less called for when a man is so mutilated that his life hangs upon a thread? Tso, gentlemen, I think you will agree with me, that the selection of the best talent to be had is the first and great- est requisite of our scheme. Hence I regard the appointment of district surgeons as a necessity to the public. There is an- other point of view interesting more particularly to practi- tioners themselves. If we are to have efficient medical provision for railroads there must be a better understanding between practitioners and railroad men, and to accomplish this it must be grafted in as a part of the general system. At present when an accident occurs medical men are called at random, by whom nobody knows, and on arriving are without authority to enforce their wishes, and are sometimes even denied requi- 30 site information ; the officials fear to commit themselves, and regard the surgeon almost as an interloper, certainly treat him as such, and finally throw the case on his hands to do the lust he can with it. Of course, nobody is responsible to him, if the patient is not capable of doing anything, and a jnst feeling of discontent is engendered. These things, it is true, lie out of the sphere of general observation, but they create ill-feeling and a dislike often to have anything to do with railroad acci- dents, if they can avoid it. I believe with the introduction of the system I have proposed all these difficulties will be easily obviated. The district surgeon, while on duty, would be an officer of the line, bound to do his best for the relief of suffeiers, and entitled to the same respect and consideration as any other | superior employee in enforcing what he deemed necessary ; while, on the other hand, he would be the local guardian of the interests of the company, as far as his own department was concerned. If railroad companies were to attempt to put a system of medical provision into operation with their present machinery, they would simply undertake an impossibility. Stations might be established, but when it came to determining the nature of apparatus to be employed, and supplying the stations with requisites, they would be at a standstill. There would be abundance of communications, the value of which non-profes- sional men could not estimate, and almost every practitioner would want something different. The time of superintendents would be so trespassed upon with questions beyond their power to determine, that the necessity of some medical man at head- quarters to take charge of the whole matter would soon be apparent; hence, while the district-surgeon would be a neces- sity to the public, a medical superintendent would be indis- pensable to the companies, alike on the score of time, trouble, and expense. Doubly so would this be the case, if the compa- nies (.fa State were to associate themselves as proposed in the Bill I shall presently have occasion to introduce to your notice. By that measure not less than a hundred and fifty stations are contemplated in this State. The two grand features of the proposal are Life Insurance and Medical provision ; and as the latter is most novel, most prominent, most difficult to carry out the chief executive officer, call him Superintendent, Medical Inspector, Surgeon-in-chief, or what you will, must be a medi- cal man. His duties would be entirely different from those of the district surgeons, and mainly administrative. Here is a scheme to be so grafted on to the railway system, that while novel and great facilities are to be afforded to the profession to relieve suffering humanity, no derangement of the ordinary 31 working machinery, no detriment to the interests of companies shall thereby occur. When we have determined upon our apparatus, similar in character for each and every station, and fixed upon the latter, and districts and surgeons, and the whole is put into operation, it must be evident to every thinking mind, that there are still a great many small matters of detail to be worked out, ere the machinery of one blends into that of the other, so as to form one harmonious whole. For instance, instructions to employees must not be such as will interfere with their other duties—we must not risk the safety of a train to assist an individual. The rights and privileges of medical officers must be so defined, that, while every facility is thereby secured to them for the most prompt and efficient discharge of their functions, they shall not be brought into conflict with other employees. Again, with regard to payments of medical men, the companies or association must know exactly what they are going to do. They make themselves responsible for payment in cases where they are not now legally so ; they extend their humane provision to all cases of casualty on their lines, and the profession must meet them half way. The duties to be performed are specific, and extend only over a short period, hence there will be no difficulty in placing these things upon a fixed basis, otherwise, while all legal difficulties are obviated, as between companies and their passengers, new ones would soon spring up between the former and practitioners. These and similar matters are within the compass of any ordi- narily clear-headed practitioner to arrange as they arise, but they must be presented in a well-digested form to the general superintendents of lines, whose labors are already incessant and arduous enough, and whose time ought not to be trenched upon unnecessarily by matters out of their respective lines of duty. There will be enough to occupy the whole time and attention of the chief medical officer where the system is per- fected. Placed as he is between the profession, whose just wishes he will of course be anxious to respond to, and the com- panies whose interests in this matter are placed in his charge, his duties will be partly secretarial. There will be a consider- able amount of correspondence with the parties between whom he stands. He will supply and have charge of all apparatus, and should inspect every station at least once a year; should be on baud, if possible, after every great accident, and watch the working of the system, and see how the duties are per- formed ; he should also embody an account of the labors of railroad surgeons in a comprehensive annual report. There will be too much for him to do to be compatible with anything like remunerative private practice; enough to fill his whole 32 time, which at all events must be paid for, advantageously to his employers. Upon his activity and energy much of the success of the plan will depend ; and at least until the system is in complete working order, he will have, if he 'would avoid general contusion and ultimate disappointment, to bend his whole energies to the task. There is nothing here really about head surgeon and district surgeon, or general duties and subordinate duties. There is nothing to interfere with the freest action of local surgeons. When occasion occurs they would be authorized to go ahead at once, with facilities placed at their command they do not now possess ; and having done their work and made their report they would be entitled to and receive their pay without any question arising as to the responsibility or non-responsibility of the company on whose line the accident occurred. I should propose that the report so made should be on a printed formula, to be kept at all stations and include the fol- lowing inquiries:—As to the distance from the station and time at which the accident occurred : what was done previous to the arrival of the surgeon : the time the patient arrived at the station, and length of time that elapsed before he was put under treatment: the exact nature of his injuries, the treat- ment and results: if dying, specifying the time and immediate cause of death; if living, how disposed of. These reports Hied and bound would make a most valuable statistical record, and would enable us to test with great exactness the success or non-success of our scheme. I shall now take leave of this part ol my subject, merely remarking, that whatever of complexity there may seem to be about if, will disappear as soon as it is put into practical working shape. As with all other new and great measures unless reduced to system, this would soon become surrounded with-difficulties, and end in failure With regard to apparatus—I have alreadv indicated, in a general manner, m my former paper, the 'kind we should ■ 5T,r% a 7Vy 8lirgl'on Wh0 is q^i^l to undertake the fn C"tf ^f 8«'-e«,n-illbeexpecte-1 to possess as many mst.uments at least as are comprised in Tiemann's forty dollar case it only to meet the exigencies of his private practice we need not therefore supply cutting instruments. Neltl 1^1 is i" to be supposed that we can suppbj to stations all the resources of large and well appointed hospitals. Country surgeons are from the necessities of their position, often obliged, in cases of acture whether simp e or compound, to make their spiints on he spot. Some adopt one contrivance, some another esne eially o meet the exigency of the moment; and wKn has well observed : « More after all depends on the tkilT and 33 care of the surgeon than on the employment of any particular kind of apparatus." All we could do would be to supply the rough material. Stretchers would be supplied to the minor or flag stations ; the main stations would of course be better pro- vided. As this subject may not come up again, I shall beg to intro- duce to your notice an apparatus specially suited for removal of a difficult class of cases, namely, those with fractures of the thigh. It is a fracture bed, invented by Dr. Robert Nelson, formerly of Canada, and now of this city. It is on the double inclined plane principle, and so constructed that the leg ope- rates as the extending weight. By this apparatus the Doctor claims to treat fractures without splints, and when properly used, without a possibility of shortening. As he has deter- mined t<> make this apparatus public, and has already given notice of a paper to be read by him on the subject, in the Medico-Chirurgical Society, it would be out of place here to do more than merely exhibit it, he having kindly given me permission to do so. On the bed from which this model was taken, I have treated one patient with perfect success, and without splints a great part of the time. What is still more to the purpo.-e, at present I have put a man with fractured thigh upon it, without a splint or support of any kind, pushed the whole on a common express cart, during Christmas week, when the roads were rough, and so sent him down without experi- encing (as he expressed it) an ache, or ajar, or a pain, from the time he left Yonkers until he was delivered at his destination. He might as well have been carried to New Orleans. I have added handles and curtains, and the whole is compact and por- table. A dozen or so might be distributed in central locations, so that on requisition by telegraph one or more could be easily forwarded to any locality where it might be "needed. [The apparatus was here exhibited and described ; one of the main objects being to show how an injured person might have the limb set at the station, be thence removed to a hotel, again to the cars, through the streets, or home to any distance, with- out disturbance, without removing him from the bed, or alter- ing his position.] I have advocated the measure now under discussion as a source ^tbrmry 16, 1862. * * * * you cannot fail, I think, in your humane undertaking it is so good and self-evident. * * * ^^..j^, iL 2S Dr. Arnold. Yours truly, V. Mott. Extract of Letter from the Same. Dear Doctor, FrIDAY' Feb™ry 21, 1862. * * * * Doubtless all Life Insurance Companies, when thev arP apphed to, wdl, at a glance, see the importance^ your noble project 43 It will not only strike them as humane, but it will appeal forcibly to their pockets, &c, &c. Yours truly, Dr. Arnold. V. Mott. Letter from J. M. Carnochan, M.D., Prof, of Surgery and Surgeon-iru Chief at Ward's Island. New York, February 15, 1862. My Dear Sir, I return you many thanks for your letter and valuable pamphlet " On Medical Provision for Railroads as a humanitarian measure as well as a source of Economy to Companies." The project is one of vast utility, and, when perfected and matured as you already seem to have done, from its general applicability, will be adopted in all localities where civilization has advanced. Communities as well as railroad companies owe you a debt of grati- tude for bringing before the notice of the public your well-devised propositions, for, although perfectly simple when once stated, yet the prac- tical form into which they have been arranged could only have been the result of much consideration and reflection. With best regards to yourself and the sincere hope that your admira- ble project may soon be carried into effect, I remain, my dear sir, Very truly yours, To Dr. Edmund Arnold. J- M. Carnochan. From Henry H. Smith, M.D., Late Surgeon-General of Pennsylvania, Prof, of Surgery University of Pennsylvania. 1112 Walnut street, Philadelphia, October 20, 1862. Sir, Your communication of October 1st, 1862, with the accompanying pamphlet "On Medical Provision for Railroads as a Humanitarian Measure," reached me two days since. You are entitled to the thanks of the community for originating so important and useful a measure, and I trust your efforts will be successful. If you will forward me a copy of the proposed bill I will take the necessary steps to obtain legislative action in Pennsylvania. Very respectfully yours, To Edmd. F. Arnold. Henry H. Smith. From Alex. B. Mott, M.D., Prof. Surg. Anat. Bellevue Hospital Medi- cal College, dtc, &c. New York, November 8, 1862. My Dear Sir, ^ I'have read with much interest your able and valuable pamphlet On Medical Provision for Railroads as a Humanitarian Measure," &c, and 44 trust that the important suggestions you have made, and the well-matured plans you have devised, will be adopted, feeling satisfied that many live9 will thus be saved, and much suffering alleviated. "■ V ishing you success in your noble enterprise, believe me, my dear Doctor, Yours very truly, Edmd. S. F. Arnold, M.D., Yonkers. Alex. B. Mott. From Frank H. Hamilton, M.D., Prof. Military Surgery, Fractures, T*,*,*-r.* I.i;eceived and read, with much interest, yonr paper " On Medical Provision for Railroads." I highly approve of the proposed p>lan, and think you deserve the thanks of the profession and public for your humane consideration of the subject. 1 hope it will be put into practical operation soon. I have thought of the necessity of some ready means to relieve the wounded in cases of accident, and in view of the want of such means, I have for years past, when travelling by rail, taken with me my pocket case and some medicines, &c, &c. Yours truly, G. J. Fisher, 45 From A. H. Baker, M.B., Prof, of Surgery Cincinnati College of Medicine and Surgery. Cincinnati, November 18, 1862. E. S. F. Arnold, M.D.—Dear Sir, I have examined the pamphlet on " Medical Provision for Railroads as a Humanitarian Measure as well as a source of Economy to Compa- nies.'' The subject is one of vast importance, and the plan proposed should meet the approbation of all parties. I hope, my dear sir, your labors may be rewarded by its adoption, and that you may long live to witness the beneficial results. With high consideration, I am, Very truly yours, A. H. Baker. From the American Medical Times, of January 25 th, 1862. In an editorial, written shortly after receiving my first small pamphlet on Medical Provision for Railroads and Steamboats, the following remarks are made: "From carefully prepared statistics it appears that in this country, during 1861, there were 63 railroad accidents, resulting in 101 killed and 459 wounded; in I860 there were 74 railroad accidents, resulting in 57 persons killed and 315 wounded. The number of railroad acci- dents for the last nine years was 1,040, giving 1,267 persons killed, and 4,385 wounded, &c. In reviewing such statistics the practical question which presents itself to every philanthropist is, how can modern travel- ling be rendered more safe ? As physicians, it is not our province to discuss the causes of railroad and steamboat disasters. The case of the injured, however, falls to our lot, and we have a direct interest in whatever tends to make our services most available in the mitigation and relief of suffering." After recapitulating the leading features of my plan, the article goes on to say: " If this, or some similar plan, were adopted by our railroad authorities it cannot be doubted that many lives now lost would be saved, and much suffering would be promptly relieved after those terrible accidents, which so often thrill the community with terror." Iu allusion to the paper on Medical Provision for Railroads as a Humanitarian Measure, > > 5^ > >^ CO I >> > .J". > j» > o '»> > v» x» > » > >> > xu> 3> ?U> > ;» >T» "> ^ > 3 ;> i > -s ■> ' ' »> . v > -> > >»» >^> > SO 5* - ,,, > > > > o > > > > ■> > - > » _■> » > "> ~> ^ > > .>>> >'J >> >> V,