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The Experimental Surgeon modern medicine at the world's first railroad hospital

Liability & Care

In 1867, the Central Pacific Railroad created their own pre-paid health plan. Employees, excluding the Chinese, paid fifty cents a month to access health care. Government subsidies covered the remaining cost. The railroad’s health plan served as an early model of today's employer-based health insurance system.

Wreck of Southern Pacific Railroad train between Sacramento and Davis, during 1894 Pullman strike. Courtesy of California State Railroad Museum.

The Central Pacific created their own health care system out of necessity. The construction of the Transcontinental Railroad brought employees to the remote West where doctors and medical facilities did not exist. Poor sanitation and a challenging climate led employees to suffer from illnesses like typhoid fever and tuberculosis. The lack of safety standards and the unique dangers of the railroad caused many accidents that injured employees and passengers. By providing health care, the Central Pacific reduced the likelihood of lawsuits. It also helped the railroad keep and recruit employees.

The Railroad Hospital

In 1867, The Central Pacific Railroad established their first hospital in a former orphanage at Thirteenth and D Streets. It was the first hospital in the world devoted to the treatment of railroad employees. A dedicated hospital building completed construction at Thirteenth and C Streets in 1869 . It admitted the first patients in February 1870.

The railroad hospital occupied a quarter of a block and cost $65,000 to construct. First floor. Illustration: Sacramento Daily Record-Union, October 11, 1896.
Doctors believed smoking placed the ailing men at ease, so the hospital contained a room dedicated to it. Basement. Illustration: Sacramento Daily Record-Union, October 11, 1896.

Considered a state-of-the-art facility for its time, the hospital had all the latest medical advances needed to treat injuries and disease. Many of the hospital's doctors were recruits from remote railroad outposts. They had experience treating the traumatic injuries suffered on the tracks. These injuries included crushed and severed limbs, compound fractures, and head injuries. Yet the practice of medicine was still in its infancy. Death from infection was common. The putrid smell of decaying flesh plagued hospital wards. Doctors did not wash their hands before surgery or clean their surgical instruments.

"Among these cases are many that are singular and interesting to medical men, comprising injuries to almost every portion of the body, rheumatism, paralysis, aneurisms, abscesses, gunshot wounds, broken limbs, cuts, etc." "General Pacific Railroad Hospital," Sacramento Daily Union, April 23, 1869.
Female doctors worked for the railroad, but not at the Sacramento hospital. Ten nurses pose on the Central Pacific Railroad Hospital grounds. Frederick-Burkett Photographers, year unknown. Courtesy of Center for Sacramento History.

A Dedicated Medical Specialty

Central Pacific Railroad Hospital doctors practiced a medical specialty called railway surgery. They had more in common with general practitioners than surgeons. Railway surgeons treated illnesses, delivered babies, counseled married couples, and performed surgical procedures. They also tested vision and hearing.

Railway surgeons did not receive any specialized medical training. Instead, they learned on the job. Professional medical societies played an important role in developing their knowledge base. They gathered at local, state, and national meetings to share new treatments and surgical methods.Rural doctors without a local society to join relied upon professional journals such as The Railway Surgeon to learn this valuable knowledge.

Example of a railway surgeon's emergency case from the 1890s. Photo: Clinton B. Herrick, MD. Railway Surgery: A Handbook on the Management of Injuries. Public Domain.

As employees of the railroad, they represented the interests of the company. They recorded injuries and treatments as part of their practice. In the event of a lawsuit, their records could determine the outcome. As a result, employees did not completely trust them.

Nixon & Huntington

Dr. Alexander B. Nixon led the Central Pacific Railroad Hospital as Chief Surgeon when the new building opened in 1870. Nixon had practiced medicine in the region for more than thirty years. He enjoyed a reputation as a competent surgeon and encouraging leader. He was a founding member of the Sacramento Society for Medical Improvement. Like most doctors of his generation, he did not engage in clinical research.

Dr. Alexander B. Nixon. Illustration: Sacramento Daily Record-Union, November 4, 1889.

In 1882, the Central Pacific brought a young railroad surgeon, Dr. Thomas W. Huntington, to Sacramento to serve as Assistant Surgeon. Huntington’s medical education at Harvard University exposed him to new scientific theories. Louis Pasteur's germ theory, which established germs caused disease, had started to gain acceptance in the medical community. British doctor Joseph Lister took germ theory one step further. He demonstrated that sterilizing surgical instruments and wounds reduced infection. Known as Listerism, asepticism, or sterile surgery, his theory changed medicine forever.

Dr. Thomas W. Huntington as he appeared in 1910. Prior to coming to Sacramento, he worked as a railway surgeon in Elko, Nevada. Courtesy of the Center for Sacramento History.

Appearing Before the Society

In 1882, Huntington accepted an invitation to appear before the Sacramento Society of Medical Improvement. He presented a paper where he praised asepticism and lobbied for it to become required practice.

Huntington’s enthusiasm and success with asepticism received mixed reactions. Some supported its use. Others claimed they did not see any decrease in deaths or infection. Nixon turned out to be one of the most vocal opponents. He tried sterile techniques himself and thought they were unnecessary. He continued to endorse the use of water to clean wounds and believed that keeping them open prevented infection.

Asepticism received similar opposition across the country, especially from older physicians. They had little education in scientific medicine. Many still treated patients with bloodletting and plant-based remedies. They did not understand germ theory. They believed the presence of pus to be a sign of a healthy wound. It signaled an infected, unhealthy wound.

“Dr. Huntington has given us a good paper. So far as we are concerned in Sacramento, we get as good results without Listerism as we do with that method.” Dr. G.L. Simmons

Saving Lives & Limbs

The lukewarm reception to asepticism did not discourage Huntington. He continued his work with sterile surgical techniques at the railroad hospital. In 1883, he opened the first aseptic operating room on the West Coast.

Sterile surgery required stainless steel surgical tools (above) because they could be easily sterilized. Previously, surgeons used tools made of wood and bone. Photo: Clinton B. Herrick, MD. Railway Surgery: A Handbook on the Management of Injuries. Public Domain.
Metal sterilizer with tray. Photo: Clinton B. Herrick, MD. Railway Surgery: A Handbook on the Management of Injuries. Public Domain.

In this environment, Huntington and his assistants witnessed a sharp decline in fatalities among those who suffered compound fractures or amputations. Before sterile techniques, the fatality rate ranged from 40-60%. After its implementation, fatalities dropped to 4-7%. With the discovery of antibiotics nearly fifty years away, prevention through sterile surgical techniques was the best tool available.

Sterile packages of catgut, silkworm, and silk ligature. Like Joseph Lister, Huntington preferred to use catgut to close wounds. Photo: Clinton B. Herrick, MD. Railway Surgery: A Handbook on the Management of Injuries. Public Domain.
Packages of sterile gauze plugged with cotton. Photo: Clinton B. Herrick, MD. Railway Surgery: A Handbook on the Management of Injuries. Public Domain.

The End of Suffering

In 1884, Huntington again stood before the Sacramento Society for Medical Improvement. He reported on the outcomes of surgeries he performed over the previous two years. The paper, “Notes on Antiseptic Surgery with Reports of Cases treated at the CPRR Hospital,” presented a handful of surgical cases from over one hundred surgeries that he performed. Not a single patient died from infection. Only one patient developed an infection that required amputation.

Huntington also addressed those who doubted the benefits of sterile surgical techniques. He urged them to end their patient's suffering. They needed to accept the mounting evidence that proved sterile surgical techniques saved lives and limbs.

"One of the most delightful features of this plan is the almost entire absence of pain." Dr. Huntington, "Notes on Antiseptic Surgery."

The members of the Society praised his efforts. Nixon declared himself "a full convert.” Simmons said he believed in sterile methods, yet he remembered similar cases where he had good outcomes without them. Dr. W.E. Briggs said Huntington’s results were admirable and remarkable.

Ongoing Innovation

In 1885, 76-year-old Dr. Nixon retired as the railroad hospital’s Chief Surgeon with Huntington named as his replacement. The following year, the Southern Pacific Railroad took over management of the hospital.

Now in charge, Huntington continued the day-to-day work of treating illness and injury. The Sacramento Daily Record-Union often reported on his efforts to treat patients at the site of railroad accidents. He also responded to the sites of other medical emergencies in the Sacramento Valley.

Thank you message to Dr. Huntington from a grateful patient. Sacramento Daily Record-Union, March 29,1892.

Huntington’s embrace of sterile surgery led him to pioneer other surgical treatments for previously fatal conditions. An avid reader of medical literature, he found inspiration and guidance in a research paper about the surgical anatomy of the appendix. After reading this paper, Huntington concluded that surgery could cure patients suffering from intestinal inflammation. In August 1891, Huntington performed the first appendectomy (removal of the appendix) in California. His patient, a Southern Pacific brakeperson, completely recovered.

The End of an Era

In 1899, the Southern Pacific moved the railroad hospital to a new facility in San Francisco. The outdated Sacramento hospital closed. A general clinic opened in the former home of Charles Crocker on 8th and F Street. It closed in 1912 following the completion of a new hospital at Second and H Streets. The new hospital housed an emergency room and general clinic until its closure in 1921. None of these buildings survive today.

Former home of Charles Crocker. Postcard, Southern Pacific Railroad Co.'s Hospital. Sacramento, California. Postmarked October 5, 1910. Courtesy of the Center for Sacramento History.

In 1899, Huntington accepted an invitation from the University of California to be Chief of the Department of Surgery for their medical school in San Francisco. Shortly after his arrival, he performed the first gastrectomy (removal of the stomach) in the West on a patient with stomach cancer. He continued to work for the Southern Pacific as a surgical consultant until 1910.

Credits:

Title Panel: Sacramento, W.W. Elliot and Co., Sacramento Daily Record Union and Weekly Union, 18-?. Courtesy of Library of Congress. Image in public domain. Panel One: Group Portrait of Central Pacific Shops Employees. Courtesy California State Railroad Museum; Wreck of Southern Pacific Railroad train between Sacramento and Davis, during 1894 Pullman strike. Courtesy of California State Railroad Museum. Panel Two: CPRR Hospital, Photographer unknown. Courtesy Center for Sacramento History; First floor, Sacramento Daily Record-Union, October 11, 1896, Chronicling America, Library of Congress; Basement, Sacramento Daily Record-Union, October 11, 1896, Chronicling America, Library of Congress; Central Pacific Hospital Nurses, Frederick-Burkett Photographers. Courtesy of Center for Sacramento History. Panel Three: Cover of The Railway Surgeon, Volume 2, Number One. Google Books. In Public Domain; Surgeon's Emergency Case, Railway Surgery: A Handbook on the Management of Injuries. By Clinton B Herrick, MD. Google Books. In public domain. Panel Four: Dr. Alexander Nixon, Sacramento Daily Record-Union, November 4, 1889, Chronicling America, Library of Congress; Dr. Thos W. Huntington, Courtesy of Center for Sacramento History. Panel Five: Sacramento Doctors, Courtesy of Center for Sacramento History. Panel Six: Operating Room, CPRR Hospital. Frederick-Burkett Photographers. Courtesy of Center for Sacramento History; Surgical instruments, Railway Surgery: A Handbook on the Management of Injuries. By Clinton B Herrick, MD. Google Books. In public domain; Metal sterilizer, packages of sutures, Railway Surgery: A Handbook on the Management of Injuries. By Clinton B Herrick, MD. Google Books. In public domain; Sterile gauze packages, Railway Surgery: A Handbook on the Management of Injuries. By Clinton B Herrick, MD. Google Books. In public domain. Panel Seven: First page from "Notes on Antiseptic Surgery with Report of Cases Treated at the CPRR Hospital," Pacific Medical and Surgical Journal and Western Lancet, Volume 28. Google Books. In public domain. Panel Eight: Newspaper clippings collage designed by Courtney Whitmore. Articles Sourced from San Francisco Daily Call and Sacramento Daily Record-Union 1880-1899. California Digital Newspaper Archive and Chronicling America, Library of Congress. “Card to the Public” Sacramento Daily Record-Union, March 29,1892. California Digital Newspaper Archive. In public domain. Thank you: Dr. Ty Smith, Kim Whitfield, Nicholas Piontek, and Chris Rockwell.