J ■ 
THE HAND IN RAILWAY . RGERY.* 
C. B. LYMAN, M D., DENVER, COLO., 
Surgeon to the Union Pacific System; Visiting Surgeon to St. Joseph's 
Hospital; Professor of Fractures and Dislocations in the 
Medical Department of the University of Denver. 
Laying aside the fact that a perfect hand adds to the 
beauty and symmetry of the human figure, we should ever 
bear in mind that it is likewise one of the most useful por- 
tions of the body, especially to the man who is obliged to 
earn his living by manual labor; that the loss of any por- 
tion of it, be it ever so small, diminishes its usefulness: a 
toe more or less makes no particular difference, but a 
finger less very materially diminishes the individuals capac- 
ity for earning a livelihood. 
The study of methods of procedure to restore this 
member to its natural condition after injury is one which 
should occupy a portion of every surgeon's attention, no 
matter how busy he is. Too many surgeons say: "Oh, 
well, it is only a finger and it will almost take care of itself; 
no need for the attention to details as in the case of a ma- 
jor operation." The amputation of a leg is called a major 
*Reprinted from "The Railway Surgeon," January I, 1895. 2 
The Hand in Railway Surgery. 
operation, but in these days of asepticism is it a major 
operation? Is it not as much of a major operation to prop- 
erly take care of a badly crushed hand and restore its sev 
eral parts to usefulness? 
The subject of the surgery of the hand, is one which 
will hardly attract the attention of the modern surgeon 
whose mind is engrossed with the consideration of the 
more showy and intricate operations; surgeons are apt to 
think only of the greater triumphs of their art, but in the 
midst of the major work there will always fall to the lot of 
the busy surgeon a host of minor cases which should de- 
mand as much care on his part as the major; of these minor 
cases a large proportion will be injuries to the hand; for, 
as we all know, the hand is very much exposed to injury in 
all pursuits of life, but more especially in the case of those 
who are obliged to earn their livelihood by working in the 
repair or erecting shops or in the switchyard of a railroad 
corporation. 
When we stop to think that the railway employes of 
the United States form a standing army by themselves, and 
when we remember also that a large proportion of them 
are employed in the hazardous positions, where their hands 
are liable to get caught in ihe machinery or between the 
bumpers or deadwoods; when we recall the fact that in 
every year 30,000 railway employes receive injuries and 
that out of that large number fully 8,000 to 10,000 receive 
their injuries to the hand, is it amiss to dwell on this subject 
It is a common saying among switchmen that a man is 
not a good switchman unless he has the "switchman's 
brand," which consists of a crippled hand; unless he has C. B. Lyman 
3 
this he is looked upon as a novice at the business, so fre- 
quent are injuries of this nature in that department of the 
railway service. We look forward to the time when a 
switchman can show as perfect a hand as any other labor- 
ing man, but that day will not come until there is some 
national legislation which will compel railway corporations 
to equip their freight cars with-some device which will not 
make it compulsory upon the switchman to step in between 
moving cars, hold up the link with one hand and the pin 
with the other, in order to make a coupling; it would be of 
some service if all of the numerous corporations could agree 
upon some universal standard of couplers, for as it is now 
a freight train cannot be made up in any yard that does not 
contain cars belonging to from 6 to 20 different corpora- 
tions, with perhaps as many varieties of couplers. No one 
knows the necessity for some such reform as this any better 
than the surgeon who has charge of the surgical work of a 
large railway corporation at one of its terminal points where 
cars are de'ivered to and received from foreign roads; in- 
jury to the hand in whole or in part will form the bulk of 
such a surgeon's work for the corporation. 
In an experience covering nearly nine years of railway 
service at a terminal point and in a large city, I find that 
about one third of all accidents I am called upon to treat 
are injuries of the hand; during the twenty months just 
passed I find that on the division of the railroad with which 
I am connected there were treated 1.571 cases of injury 
and that out of this number 530, or 33.73 per cent., were 
injuries to the hand; the injuries sustained were of all va- 
rieties and of all grades of severity, from a simple contu- 4 
The Hand in Railway Surgery. 
sion of the soft tissues without fracture of bones or lacera- 
tion of the skin, to crushes so severe that but one glance 
by an experienced surgeon was needed to say that the part 
was irreparably lost. 
The points which should be indelibly impressed upon 
the surgeon's mind are that in the treatment of injuries of 
the hand conservatism is the first thing to be thought of, 
and next, that by strict adherence to aseptic methods many 
a finger can be restored to usefulness which would have 
been lost had the case fallen into the hands of one who, 
though he might be a conservative and a conscientious sur- 
geon, was lacking in familiarity with aseptic technique. 
It depends upon good judgment and experience, and 
as much or more upon the latter, to say whether a crushed 
finger, thumb or hand can be saved; or whether amputa- 
t:on must be done, and if the latter is the only alternative, 
to say where it must be done; this quality in a surgeon can 
only be acquired by actual experience, and the railway sur 
geon is the one in all probability who has had more expe- 
rience than his fellow practitioners. Conservatism and 
asepticism go hand in hand, for it is only by the assistance 
of the latter that the former can be put to its best use; by 
strict adherence to correct aseptic methods we can with 
safety give Nature a show that she may, if possible, bring 
back to life shreds of tissue which have been badly crushed 
without the danger of suppuration and septic infection; we 
many times see tissues regain activity under aseptic dress 
ings which seemed almost crushed to death. 
The surgeon who has to deal with railway injuries does 
not have the best, of material to work with to get aseptic C. B Lyman 
5 
results; the very nature of the work which these men do in 
itself means dirt of all kinds; these cases come to us with 
their hands covered with oil, grease, coal dust and cinders; 
all of which have been ground into any wounds which may 
exist; in addition to this we often find these cases enveloped 
in tobacco juice, shellac varnish or some other popular and 
nasty dressing; if with such unfavorable conditions the sur- 
geon can obtain a perfect result, should it not be to his 
credit as much, or more than, that he should obtain similar 
results in some major operation where he has had the most 
favorable surroundings and has had twenty-four hours in 
which to get the field of operation into a thoroughly asep- 
tic condition? By proper methods of procedure the field 
of operation in these cases can be made aseptic and asep- 
tic results can and should be obtained. To illustrate the 
methods which should be followed and to show what con- 
servatism will do it may not be out of place to cite a few 
cases. 
J. D., a car-repairer, was kneeling down to inspect the 
brake beam on a car which was standing on a side-track, 
unprotected by a flag; he had one hand on the rail close to 
the wheel; an engine backed in on the track unbeknown to 
him and started the car; one wheel ran over his hand diag- 
onally, taking off completely the little finger at the meta- 
carpo phalangeal joint, the ring finger at the second pha- 
langeal joint, the second and first fingers at the last phalan 
geal joints, the skin and soft parts were almost entirely 
stripped from the bones on the dorsal surface of the hand 
and were hanging in shreds; there were numerous ragged 
lacerated wounds on the palmar surface and some of the 6 
The Hand in Railway Surgery. 
flexor tendons were laid bare; the thumb was torn open 
down to the bone from the tip down into the palm of the 
hand; the hand was black with oil, coal dust and cinders 
which had been literally ground into the wounds. He was 
placed on the operating table, anaesthetized and with a stiff 
nail brush and an abundance of liquid soap the hand was 
most thoroughly scrubbed, the wounds were scrubbed in 
the same manner as the skin until every particle of dirt 
was removed; the parts were then thoroughly washed out 
with a 1:1000 solation of corrosive sublimate. After ap- 
plying the tourniquet the ragged edges of all the skin flaps 
were trimmed until they were made regular, and in the case 
of the fingers which had been amputated nothing was re- 
moved except the ends of the bones, a sufficient amount be- 
ing taken off to allow the irregular flaps of the skin to be 
brought up over the ends. All of the lacerated skin was 
replaced and carefully stitched with catgut, no drainage 
being used; the dressings were then adjusted, which con- 
sisted of a free dusting with Sennine, an antiseptic powder 
which I have used for the last 9 months entirely in place of 
iodoform; bichloride of mercury gauze was then applied in 
place of iodoform gauze. The dressings were changed at 
the end of twenty-four hours on account of oozing of blood 
and after that not until eight days; the patient made a rapid 
recovery, all lacerated wounds healed; there was no loss of 
tissue by narcosis except a piece about the size of a silver 
quarter on the dorsal surface of the hand, which under 
Sennine dressings separated and the surface left healed 
without any suppuration. 
The point of interest in this case is the fact that the C. B. Lyman. 
7 
parts were very badly lacerared and their vitality seemed 
doubtful, even to one who had seen a great deal of that 
variety of injury, and still we lost only one piece of skin 
the size of a quarter; in these cases I rarely do a classical 
amputation, but resort to what I call patchwork, utilizing 
the skin shreds to cover the ends of the bones instead of 
taking the finger off higher up in order to make a pretty 
job. It is not beauty so much as usefulness that these pa- 
tients require, and an eighth of an inch of a finger, to a 
laboring man has a commercial value. 
F R., a switchman, had his finger caught between the 
coupling-pin and the deadwood in making a coupling; the 
ring finger of the right hand was split open from the tip to 
the palm of the hand, and the flexor tendon was laid bare; 
the little finger had the soft parts completely severed, noth 
ing but the bone remaining intact. He consulted another 
surgeon in the emergency who dressed the wounds without 
even washing them out and made no attempt to restore 
the soft parts to their natural position. I received him two 
hours later and scrubbed his hand in the usual manner, 
carefully stitched the lacerated wound together and applied 
a Sennine dressing. In the case of the little finger, ampu- 
tation alone was indicated, but this the patient refused ab 
solutely to have done, so the finger was washed and the 
same dressing applied as was applied to the other. The 
ring finger was well in ten days and when last seen was as 
useful as before the accident; the end of the little finger 
formed a dry slough without suppuration and was still in 
that condition when last seen. 
Under such methods we are enabled to take our 8 
The Hand in Railway Surgery. 
crushed, irregularly lacerated wounds and accurately ap- 
proximate the edges with sutures, whereas the surgeon who 
does not have absolute confidence in the thoroughness of 
his methods will leave such a wound open to granulate, 
with the certainty of contraction of the scar afterward and 
the probability that tendons will be bound down to such a 
degree as to materially interfere with the future usefulness 
of the part. 
L. N., a section laborer, had a rail fall, striking his 
hand; it caught the ring finger of the left hand, cutting it 
completely through, with the exception of a small bridge of 
tissue on one side, which included the artery on that side; 
the parts were thoroughly scrubbed with soap, ether and 
corrosive sublimate solution; the fragment was stitched in 
place, a Sennine dressing and splint applied, union took 
place promptly and a serviceable finger resulted. 
Compound fractures of the bones of the hand, and 
especially of those of the fingers, are everyday accidents, 
and when such cases are properly cared for they should 
give no more trouble than a simple fracture; such results 
are not to be obtained, however, except by the strictest 
attention to cleansing of the parts and to proper methods 
of dressing; a piece of iodoform gauze clapped onto a 
wound does not mean that the wound has been dressed 
either aseptically or antiseptically, but unfortunately many 
think so. These cases can all be made aseptic if taken in 
hand early; lacerations can be stitched up, tendons united, 
a Sennine dressing applied without drainage, with the as- 
surance that union will take place quickly and the fracture 
be converted into a simple one.