Age REPmr/F Series. No. 9 
A Few Things That May Add to the 
Convenience of Railroad 
Surgeons, 
WITH WHICH IS PRINTED AN ARTICLE ON 
Bloodless Amputation at the Hip Joint 
at One Sitting, and with 
One Needle. 
BY 
STEWART LEROY McCURDY, M. D., 
DENNISON, O., 
Surgeon to , C., C. <Se St. L. Ry., Professor Orthopedic Surgery, Ohio Medical University. 
Orthopedic Surgeon Protestant Hospital, Columbus, O., Member American 
Orthopedic Association, Treasurer Ohio Association 0/ Railway 
Surgeons, Vice President Ohio State Medical Society, 
Member A merican Medical Association, etc. 
Dr. ST F WAR I _ MrCURDY, 
91? Penn Avenue 
PITTSBURGH, (»a. 
REPRINTED FROM 
THE RAILWAY AGE AND NORTHWESTERN RAILROADER, 
CHICAGO. A Few Things That May Add to the Convenience ol 
Railroad Surgeons. 
BY 8TEWAKT BE ROY MC OTJEDY, M. D., DENNISON, OHIO. 
In order that the work of a railroad surgeon may be 
done with the least possible labor to himself and the 
most advantage to his patient, I have constructed a 
railroad stretcher, a flap retractor, a lounge and oper- 
ating table, a fracture bed, and an ambulance car. 
The stretcher, shown in Fig. 1, resembles other 
stretchers, except that it is narrower and has four 
FIG. 2. FI.AP betbaotob. 
handles at the corners, and a drop handle in the cen- 
ter at either side. It is composed of two side bars 6 
feet long, jointed to two cross bars, with another joint 
in the middle of the cross bars which, when folded, al- 
lows the side bars to come together. When closed it 
is secured by straps and makes a compact bundle 
light enough for one man to carry for any ordinary 
distance. To obviate uncoupling of coaches you may 
pass this stretcher through the window just as con- 
veniently as through the door, and to make the pa- tient rest comfortably in the coach remove the back 
of one seat near the middle of the coach and place the 
patient on three cushions, which is the most comfort- 
able position to be secured in a railroad train. The 
advantage of the stretcher over the one now in use is 
2 
FIG. 1. BAILWAY STKETOHEK. 
apparent. It is 6 feet long, 22 inches wide, and 
weighs about 18 pounds. 
Second, the flap retractor Pig. 2. In performing over 
one hundred amputations one of the most unsatisfactory 
steps in operating has been to saw the bones off with- 
out doing great damage to the soft parts with the saw. The three-tailed bandage, so long in use for retracting 
the muscles and soft parts back to where the cut is to 
be made through the bones, has in my hands at least 
served a very imperfect purpose. To do the very best 
it was always impossible for me to keep the muscles 
or the assistant’s fingers away from the saw’s teeth, or 
from preventing the saw from catching in and tearing 
the veteran muslin retractor. The retractor about to 
be described was made because I had use for it, and is 
presented because other surgeons may have found the 
same drawback to the muslin retractor, and may also 
find an equal need for something better. In amputa- 
ting through the femur or humerus the blades can be 
closed tightly around the bone and all soft tissues 
drawn back to where the bone is to be sawed off, with 
ease. As can be seen, the blades are provided with 
handies, which are bent back so as to throw the as- 
sistant’s fingers back of a line with the saw. When 
not in use the blades can be taken apart and kept in 
an aseptic condition. 
Fig. 3 represents a lounge and operating table 
3 
FIG. 3. I.OUNGE AND OPEHATING TABLE. 
which, when closed, answers the purpose of any ordi- 
nary lounge found in a physician’s office. It at the 
same time can be converted into an operating 
table of any desirable height either with the 
patienton or off. It can also be converted into a 
simple inclined plane of any angle. This in- 
clination can be secured from either end and will 
be more thoroughly appreciated in resuscita- 
ting patients from ether or chloroform narcosis. The 
lounge is provided with stirrups for the feet when it is 
desired to use it for gynaecological operations or 
lithotomy. The half elevation can also be had with 
the projection either toward the head or toward the 
foot. This is desirable when the operator desires to sit down. The extreme height of the table is 33 inches 
and width 2 feet. In the Columbus Medical Journal 
during 1885 there appeared an article on “A new frac- 
ture bed,” with a description of the bed at that time. 
Since that date the bed has been greatly improved, but 
4 
FIG. 4. STJJRGICAIi BUD. 
those improvements have never been published, except 
in a treatise for the treatment of fractures by Dr. 
August Schreiber, published in Berne, Switzerland. The bed (Fig. 4.) may be described briefly as fol- 
lows: 1. Head incline. 2. Lower extremity double in- 
cline planes. 3. The drop-trap. 
The third feature, deserving accurate description, is 
the “drop-trap,” constructed with the object of doing 
away with the unhandy bed pan. This trap is com- 
posed of a double frame filled in with coarse strips of 
heavy cloth woven in every direction, so as to give 
strength and endurance and at the same time 
add lightness to the structure. This is up- 
holstered with the best of heavy canvas, the 
same as used on the adjustable frames, besides 
being reinforced with good springs and cushion 
material, after the style of cushioned furniture. The 
drop-trap extends transversely across the middle of 
the bed, closely fitting with the outside frame, and is 
attached behind with hinges to the cross brace, so that 
when it is lowered for use it turns put of harm’s way 
toward the foot of the bed where it is retained by 
means of two hooks. Occupying as it does the middle 
of the bed where the weight of the body is most de- 
pendent, it substantially supports the canvas and fur- 
nishes a very pleasant cushion for the nates. 
Since publishing a description of an ambulance car 
in The Railway Age in 1891, showing a car 30 feet 
long, with one Pullman bunk and a large room at one 
end to be used for an operating room, a dining room, 
a sitting room, or for the remains when the car is used 
for funeral purposes, and affording other advantages 
proportionately smaller, I have consulted a number of 
railroad officials, and upon their advice have changed 
the original plan so as to make the car the size of a 
standard Pullman car or day coach. 
The observation room A, as shown in Fig. 5, to be 
used for a sitting room, a dining room, etc., is in the 
rear end of the car, and has four windows on either 
side. It is to contain a number of chairs and a folding 
table to be used for office work or when necessary for 
a dining table, B. 0 and D show two ordinary Pull- 
man bunks with a sleeping capacity of eight. E 
shows a state room containing an ordinary Pullman 
bunk next to the window and a couch G next to corri- 
dor, and off from which F is a water closet and wash 
5 6 
FIG. 5. AMBULANCE CAB FLOOB PLAN. room. Leading from corridor O is a door 
into wash-room I and from I to a door to the water- 
closet, H. J represents the kitchen, which contains a 
range for cooking and for the purpose of heating 
water for operations and for sterilizing instruments 
and dressings. J also contains a sleeping bunk for a 
porter. K represents a closet for the storage of surgi- 
cal instruments, stretchers and general storage. L rep- 
resents an operating room. This room contains an 
operating table, M, made narrow enough to be wheeled 
through the corridor 0 to the Pullman bunk. The 
patient can be lifted over the Pullman bunk into the 
state-room, or on the bed arranged at C. N repre- 
sents a wash-bowl with hot and cold water, to be 
used during operation. Two corner doors, 8 and T, 
are made so that a stretcher containing an injured or 
sick person, or a coffin, may be taken into the oar 
without uncoupling the car. This has been a great 
difficulty I have experienced at wrecks in transport- 
ing the injured. To get a patient into a car in the 
center of a train we are compelled to uncouple and 
separate the cars or remove the patient from the 
stretcher and carry him in the arms of three or four 
men up the steps, over the platform and through the 
door, always a difficult operation. Every railroad sur- 
geon has tried it and knows from grievous experience 
the truth of this statement. After all this labor by 
the physician and his attendants and suffering on the 
part of the patient we encounter another obstacle, viz: 
the securing of a place for the patient to rest. To 
place him on the stretcher again and place this on 
cushions would require the removal of one seat back, 
which would necessitate the using of three seats in the 
coach. At the end of the journey all these difficulties 
would again be encountered. While the labor of four 
or six men required to handle the patient is consider- 
able, it is not to be compared with the untold suffer- 
ing to which the patient himself is subjected, even in 
the most careful manipulation. With corner doors 
and a stretcher that will pass through them, all this 
trouble can be obviated. Doors S, T and U are made 
three feet wide, which will admit any size stretcher. 
When it is desired to use the car for funeral purposes, 
7 which, to my mind, is one of its principal uses, the re- 
mains can be placed at M, aud those desiring to view 
them can pass in at S and out at T without disturbing 
the privacy of the mourners, who are in the other end 
of the car. The car will give sleeping accommoda- 
tions for thirteen and a porter comfortably, and has 
every convenience of any private car, with every ap- 
pliance of the most modern and improved surgical op- 
erating room. 
The hospital system has been adopted by almost all 
of the large railroad systems of the west. They 
have recognized the economy of the hospital system, 
and have shown greater energy in this matter than the 
eastern railroads. With patients concentrated at one 
point in large hospitals, managed entirely by the 
railroad company, the expense, which is now enormous 
when the patients are taken care of, one here and one 
there, with special nurses day and night, is reduced to 
a minimum. In short, the hospital system is made 
more possible by use of a car similar to the one de- 
scribed above. 
8 
Bloodless Amputation at the Hip Joint at One Sit- 
ting and with One Needle. 
BY 8. Ii. m’oUBDY, M. D., DENNISON, OHIO. 
Those desiring to make a study of the various meth- 
ods of amputation at the hip joint are referred to £he 
articles of Senn (1), Parham (2), Murdoch(3). 
The method herewith described has some advan- 
tages and has controlled hemorrhage perfectly, both 
in amputations at the shjulder and hip. An objection 
is argued that it does not control hemorrhage from 
some branches of the internal illiac artery. While it 
is true that some hemorrhage may result from practic- 
ing this method it cannot be in sufficient quantity to 
(t). Bloodless amputations at the hip joint by a new method, 
byN. Senn, M. D., Chicago, 111.—Chicago Clinical Review, 
February, 1893. 
(2j. Amputation at the hip joint by Wyeth’s bloodless 
method, by F. . Parham, M. D., New Orleans, La.—Journal 
American Medical association, Dec. 23, 1893. 
(3). Contribution to the study of Amputations at the hip 
joint, by J. B. Murdoch, M. D., Pittsburgh, Pa.—Annals of 
Surgery, January, 1893. cause alarm. The merits of the operation will not be 
considered, for surgeons who have made a study of the 
papers above referred to can form their own conclu- 
sion as to the method they desire to use. 
The operation on hip joint amputations is performed 
as follows, Fig. 1: 
First draw a line from the most prominent point of 
9 
Fig. 1. 
the greatet trochanter to the perinseum. The needle 
is entered on this line at a point just internal to the 
femur, and is passed directly through the thigh so as 
to make its exit just below the tuber ischii. Passed 
through at this point the needle will be external to all 
the important bloodvessels, and the only hemorrhage 10 
possible will be from the smaller vessels upon the ex- 
ternal aspect of the thigh. A figure of eight is now 
made by throwing a round rubber tourniquet around 
the projecting ends of the needle, over the internal as- 
pect of the thigh, sufficiently tight to destroy femoral 
pulsation beyond the tourniquet. The flaps are now 
made, which is followed by disarticulation. After 
ligating the blood vessels, the cord and needle are re- 
Fig. 2. 
moved and the stump is ready for liual dressing. The 
point of the needle should be guarded, as Wyeth sug- 
gests, with a cork. 
The second cut, Fig. 2, is prepared in view of carry- 
ing out the same idea of a bloodless amputation at the 
shoulder joint. The steps in such an operation are at 
once suggested to the surgeon, after having studied 
the rules laid down for the hip operation.