Knowing the lessons of past disasters is necessary in disaster planning. Such knowledge paves the way for creating a plan that anticipates the patterns, as well as the impediments, of behavior and injuries encountered in most events. On September 4, 1904, a head-on “butting” collision of two Southern Railway passenger trains traveling at high speeds occurred near New Market, Tennessee, killing 56 passengers and crew and injuring 106. It was the worst civilian disaster of its kind in eastern Tennessee, according to one Knoxville newspaper. An historical analysis of the events of this mass casualty incident and the medical and community response may serve as a template for modern disaster management and the role of surgeons in that management.