Moments in Surgical History |

Railroad Surgery

Ira M. Rutkow, MD, MPH, DrPH
Arch Surg. 2002;137(5):624. doi:10.1001/archsurg.137.5.624.
Text Size: A A A
Published online


BETWEEN THE END of the Civil War and World War I, the massive development of America's railroad system brought about a necessity for complex health care delivery systems, including contract practice and group hospitalization, to treat workers and passengers. The Baltimore & Ohio Railroad may have used a physician's services as early as the 1830s. By the time of the Civil War, the Chicago & Galena Union, Illinois Central, Chicago & Milwaukee, Michigan Central, Michigan Southern, and Lehigh Valley railroads all employed physician-surgeons on a part-time basis. As rapid growth took the railroads farther into the undeveloped areas of the West, it became necessary to implement medical services overseen by full-time, "chief" physician-surgeons. The hiring of both chief and local physician-surgeons was motivated not only by the extremely hazardous conditions of railroad construction but also by companies' interest in protecting themselves from increasing numbers of lawsuits. Thus, by the 1890s, most of the major railroad carriers had or were in the process of developing some form of in-house medical organization. By World War I, nearly 14 000 physicians (approximately 10% of the nation's total supply) worked either full-time or part-time for railroad companies.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

A railroad hospital car as seen from the transportation and recovery room looking into the operating room. A narrow passageway to the opposite end of the car appears on the right (author's collection).

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles