SOCIETY PROCEEDINGS
1895
Journal of the American Medical Association
It is understood that papers presented before this body are not written to advertise either the writer or this institution. There are in railway surgery, as we find throughout the broad domain of medicine and surgery, many disputed points, many unsettled questions. That stalwart fellow-the engineer-who, for hours at a time stands at his post on the engine, while the vestibule flyer is being hauled across great stretches of our country, knows very well the character of the track before him, the
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... ature of the different grades and curves. So too, the cap¬ tain of an "ocean greyhound" must know well the course over which his vessel must pass, to insure his passengers comfort and safety. The milway surgeon, in turn, should not only have a fair knowledge of medicine and surgery, but he should as well know something of medico-legal questions ; for the course over which his bark may drift is often quite rocky. One object of this institution is to seek for Truth ; another, is to see that Justice be allowed to sit supreme on her throne. If this institution should ever adopt a motto, let "Railway Surgery, Truth and Justice," compose not only the frame¬ work, but the entire front, from the ground floor, up. Let us, then, ever be found ready to aid in working out difficult problems, in sifting the good works of others, in selecting truths and valuable facts for the advancement of railway surgery. I have said that in this line of surgery we have disputed points. Reference to our program will show that the topic under discussion is one of them, or this paper would not have been written. Now I assure you, that the grounds I shall take, and the effort I shall make in the discussion of this question, are not for the purpose of outdoing my opponent in any respect. It is simply with a desire that we may after sifting, secure enough grain to establish a standard by which all may be guided in the future. I shall first folio w a line of reasoning, or rather of inquiry, looking in the direction of the injured person. THE INJURED PERSON. Railway surgery compels us to give our first aid to the injured. So we will first consider the injured man. Now is it policy for corporation and surgeon to combine and place their work on paper and on the records of the court against an injured person? I think not. So far, I have found little trouble in securing the full con¬ fidence of the majority of my patients, and, in the course of a few days, when they are able to talk, usually succeed in drawing from them a full and satisfactory history of their case, and this too, in a legitimate way. In case of slight injury where the surgeon may detect a disposition on the part of the injured person to magnify his trouble and bring suit, is it not possible for him while taking the history of the case, to include in a general way, a state¬ ment from the patient as to the cause of the injury-to get the truth, which should be all he will require for the treat¬ ment of the case, for a clinical record, and for use as a wit¬ ness? I think so. One truth sworn to by either surgeon or patient, and cor¬ roborated by the other, is worth more than a thousand affi¬ davits secured under pressure. Suppose the injured party testifies that he has refused to give his signature, and that he resented the kind offer of the surgeon? What effect will such testimony have with the jury? Granting, then, that a signature has been procured by the surgeon, what effect will it have on the injured person? Will he not think that his surgeon is unduly exercised over his case, and will it not arouse suspicion, and at once suggest to his mind litigation? Will not such a course create a prejudice in his mind against the corporation, and will it not call forth unjust and un¬ necessary criticism from both friends and the public? Having signed a paper and coupled with it delay, will he not feel or perhaps imagine that he has entered into bonds, or been drawn into a contract whereby he may have been taken advantage of, that perhaps his injury is even of a more severe character than he has been taught to believe, and,asa result-in some cases-may we not get anxiety, worry, and possibly a deranged condition of the mind? May we not nid in developing traumatic neurasthenia, or a hystero-neurasthenia, which will place the case in the hands of the neurologist, and which alone might eventually be the means of his bringing suit for many times the amount of the original injury? I repeat, that in some cases I believe it is possible for such a turn of affairs to take place. I am aware that the last question which I have raised car¬ ries our investigation into a delicate field. Not only does it take up the physiologic element of the topic-the effect of grief, anxiety, worry and suggestion upon the mind, which in itself would furnish material for a paper, and which I do not care to discuss further, but it also involves the economic principle of compromise. I will, however, offer in support of the opinion which Í have advanced in regard to the psychologic and economic element of this question, a brief quotation from Dr. W. B. Outten's valuable paper on "Traumatic Neuroses;" "Com¬ pensation," as viewed by the writer, "does not possess the incidental elements of worry and harassment that obtain when litigation is indulged in. We are free to confess that in our views, the influence of compromise is great. It re¬ lieves the individual of all the attendant worries incident to litigation ; its influence is in the direction of mild, normal and unruffled action." ' Again, granting that the surgeon has himself procured the signature of the injured party, suit is brought and the sur¬ geon takes the witness stand with a history of the case over the signature of the plaintiff before him, and gives his testi¬ mony accordingly. Now, what effect will this surgeon's testimony have with the jury? I think the effect will be most damaging, both to surgeon and corporation. Having, for the time being, disposed of our injured per¬ son, let us turn whatever power we may have left in our searchlight upon the corporation, and what shall we find? We shall find among the officers of the company a surgeon, an attorney, with some a claim agent, and with others, an adjuster. THE DUTIES OF EACH. Now for what purpose are these gentlemen employed? 1. The surgeon is employed to do surgical and medicolegal work. 2. The attorney or counsel is employed to do legal work, to try cases in court, to give legal advice, etc. 3. The claim agent, or adjuster, is employed to investigate all claims, to ascertain the causes of accidents, to visit wit¬ nesses, to secure all the information possible from various sources for the use of himself and the attorney, and last, but not least, to pay off claims.
doi:10.1001/jama.1895.02430110025002
fatcat:ys77qi57wfa2zpaobsnbqjipfe