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THE
ESSENTIALS OF BANDAGING;
INCLUDING THE
MANAGEMENT OF FRACTURES AND
DISLOCATIONS,
WITH DIRECTIONS FOR USING OTHER SURGICAL
APPARATUS.
ILLUSTRATED BY 122 ENGRAVINGS ON WOOD.
BY
BERKELEY HILL, M.B. LOND., F.R.C.S.,
Instructor in Bandaging, &c., in University College, Assistant
Surgeon to University College Hospital, and Surgeon to Out-patients
at the Lock Hospital.
_SECOND EDITION, REVISED AND ENLARGED._
LONDON:
JAMES WALTON,
BOOKSELLER AND PUBLISHER TO UNIVERSITY COLLEGE,
137, GOWER STREET.
1869.
LONDON:
BRADBURY, EVANS, AND CO., PRINTERS, WHITEFRIARS.
PREFACE TO THE SECOND EDITION.
In laying a Second Edition before the public, I have decided not
to alter the scope of this little work, but simply to endeavour
to increase its usefulness, by remedying omissions, and by adding
new instructions where such appeared desirable. I have ventured to
insert, as an Appendix, lists of the preparations requisite for the
sick room and for the operating room before the ordinary operations
of surgery are performed; also, lists of the instruments and
appliances requisite, or possibly useful, in performing forty-nine
different operations on the human body. It is hoped that, by giving
the surgeon a list, such as most operators draw up in manuscript for
their private use, whereby they may check their preparations before
proceeding to operate, some trouble may be saved.
14, WEYMOUTH STREET, W.
_November, 1869_.
PREFACE TO THE FIRST EDITION.
The descriptions and directions for using surgical apparatus in the
following pages, are those originally prepared for oral delivery in
a short course of practical lessons in bandaging and the application
of surgical apparatus, given by me in University College Hospital. No
attempt is made to include all efficient modes of treating surgical
injuries: it is merely proposed to supply the student or practitioner
with instructions by which he may refresh his memory when about to
employ the ordinary surgical appliances.
The drawings are by Mr. R. W. Sherwin, who has taken much pains to
furnish exact representations of the apparatus, as it was applied by
myself for his delineation. The directions for giving chloroform have
had the advantage of Mr. Clover’s revision before publication.
14, WEYMOUTH STREET, W.
_October, 1867_.
CONTENTS.
CHAPTER I.
BANDAGING.
PAGE
_General rules._—Different materials of bandages.—Position of
the operator.—Mode of holding the bandage.—Varieties
of turns; the simple spiral; the reverse; the figure of 8. 1-3
_Bandaging the head._—The common roller.—The knotted
bandage.—The Capelline bandage.—The shawl cap.—The
four-tail bandage.—Fastening ice bladders to the head.—Compressing
the jugular vein 3-8
_Bandaging the trunk._—The breast.—The groin.—After operation
for hernia.—For tapping the belly.—The T-bandage.—The
strait jacket.—Manacles for delirious patients.—To
suspend the testicles 8-13
_Bandaging the upper extremity._—The fingers.—The thumb.—The
hand.—The fore-arm.—The elbow.—The shoulder.—The
axilla.—Wound of the palmar arch.—Bleeding at
the elbow 14-20
_Bandaging the lower extremity._—The foot.—The leg.—The
thigh.—The heel.—The toe.—The knee.—A stump.—Extending
a stump.—The many-tailed bandage.—Elastic
socks 21-24
CHAPTER II.
STRAPPING.
_General rules._—Strapping the breast.—The testes.—Joints.—Ulcerated
legs.—Scott’s mercurial dressing 25-29
CHAPTER III.
TREATMENT OF FRACTURES.
_The head and trunk._—Of the lower jaw; by the external splint
and bandage; by interdental splints, Morell Lavallée’s
plan; fitting a cap to the teeth.—Of the ribs; by
plaster; by a body roller.—Of the pelvis 30-37
_The upper extremity._—Of metacarpal bones; by a gutta-percha
glove; by a ball of tow.—Of phalanges.—Of the lower
end of the radius; by the pistol splint; by the gutta-percha
gauntlet.—Of both bones of the forearm.—Of the
olecranon; by figures of 8 and an inside splint; by
Hamilton’s plan.—Of the humerus near the elbow; by
lateral hollowed splints; by a gutta-percha =L=-shaped
splint.—Of the shaft of the humerus.—Of the anatomical
or surgical neck, and of the great tuberosity of the humerus,
by a cap for the shoulder.—Of the acromion.—Of the
clavicle; by an axillary pad and elevation of the elbow; by
a figure of 8 behind the back; the American ring pad 37-59
_The lower extremity._—Rupture of the tendo Achillis.—Separation
of the epiphysis of the os calcis.—Fracture of the
fibula, by Dupuytren’s splint.—Of the tibia, by
McIntyre’s splint; slinging the splint; elevating it on a
block.—Transverse fracture of the tibia, by lateral
splints; in the flexed position.—Of the patella; by back
splint and figures of 8; by Malgaigne’s hooks; by strapping
plaster and stick.—Of the shaft of the femur; by
Liston’s method of using the long splint; by using elastic
extension; Coxeter’s elastic perineal band; elastic stirrup.
By continuous extension with the limb bent; tendency to
angular union; double incline planes; slinging the
double incline planes in fracture of the neck of the femur;
by continuous extension of weight and pulley 59-80
The starch bandage.—The plaster of paris bandage.—Plaster
of paris splint.—Gum and chalk and other stiffening mixtures.
—Sand-bags.—Cradles; Salter’s swing cradle 81-90
Leather splints; Splint for the hip 90-94
CHAPTER IV.
DISLOCATIONS.
_General rules._—Of the lower jaw.—Of the clavicle.—Of the
shoulder; signs of dislocation into the axilla; when beneath
the clavicle; when behind the scapula. Modes of reduction;
by the heel in the axilla; by simple extension. The
clove-hitch knot.—Of the elbow, signs when both bones
go backwards; distinctions between dislocation and
fracture near the elbow; the mode of reduction by the
knee inside the fore-arm; by extension at the wrist.—Of
the radius, only, by extension at the wrist.—Of the thumb
and fingers; handle for commanding the phalanx.—At
the hip; signs of dislocation backwards, reduction by
extension; by manipulation or leverage; signs of dislocation
downwards, mode of reduction; signs of dislocation
on to the pubes, mode of reduction.—Of the knee;
incomplete, lateral, and posterior; mode of reduction.—Of
the patella, mode of reduction.—Of the foot, mode of
reduction 94-110
Scarpa’s shoes.—Varieties of talipes; equinus, varus, valgus;
points to be attended to in fitting the shoe.—Casting in
plaster of paris 111-114
CHAPTER V.
MISCELLANEOUS.
The Hair suture.—The eye douche, drops for the eye.—Syringing
the ears.—Epistaxis; Ice-cold injection; Plugging
the nares; Belloc’s sound.—Drawing teeth; varieties
of forceps; extracting incisors and canines, bicuspids,
upper molars, lower molars, wisdom molars, roots; the
elevator.—Stopping bleeding after extraction.—Sore nipples;
nipple shields.—Plugging the vagina; Kite’s tail
plug for vagina.—Injecting the urethra. Catheters,
silver; different kinds of flexible catheters and bougies;
conformation of the urethra.—Passing catheters and
bougies; difficulties in doing so; passing the female
catheter.—Washing out the bladder.—Tying in catheters.—Position
for lithotomy.—Bed-sores, applications to
prevent the formation of bed-sores; the floating bed; the
water-cushion.—The stomach-pump, when used to empty
the stomach or to inject food.—Transfusion of blood;
precautions; mode of using the apparatus.—Tourniquets;
the Ring; Petit’s; Signoroni’s; Carte’s; Lister’s; the
make-shift.—Mercurial fumigation; general; local.—Hot
air baths.—Vapour baths.—Sick carriage.—Cupping.—Junod’s
boot.—Leeches.—Stopping leech bites.—Tents.—Setons.—Drainage
tubes.—Issues.—Trusses, requirements
of, inguinal, femoral, umbilical, Salmon and Ody’s.—Cauteries,
iron; gas; galvanic. Caustics.—Vesicants,
mustard, cantharides, iodine.—Corrigan’s hammer.—Poultices
and fomentations.—Lister’s mode of dressing
with carbolic acid.—Irrigation; Esmarch’s irrigator.—Administration
of chloroform, precautions; dangers;
methods; Clover’s inhaler.—Artificial respiration.—Local
anæsthesia.—Ether spray, pulverised fluids.—Chloroform
vapour to the uterus.—Subcutaneous injection.—Collodion.
—Vaccination 116-192
LIST OF APPLIANCES FOR THE OPERATING ROOM AND THE SICK
ROOM.—LIST OF SEDATIVES AND RESTORATIVES.—FOR
THE ARREST OF HÆMORRHAGE 195-197
LIST OF INSTRUMENTS EMPLOYED IN OPERATIONS—
ON THE HEAD AND NECK.
Trephining the skull.—Operations on the eye.—Hare-lip.—Resection
of the jaw.—Excision of the tongue.—Cleft
palate.—Excision of tonsils.—Laryngotomy.—Tracheotomy 198-202
ON THE TRUNK.
Removal of breast or tumours.—Nævus.—Tapping the pleura.—Tapping
the belly.—Colotomy.—Ovariotomy.—Cæsarian
section.—Strangulated hernia.—Radical cure of
hernia.—Hæmorrhoids.—Fistula in ano.—Cleft perinæum.—Extirpation
of the cervix uteri.—Amputation of
the penis.—Circumcision.—Excision of testis.—Tapping
a hydrocele.—Vesico-vaginal fistula.—Retention of urine.—External
urethrotomy.—Lithotomy.—Lithotrity.—For
removing foreign bodies from the urethra and bladder 203-210
ON THE LIMBS.
Ligature of the larger arteries.—Resections: of the head of the
humerus, the elbow, the hip, the knee.—Removal of
necrosed bone.—Amputations: at the shoulder-joint;
arm; fore-arm and wrist; metacarpus; hip; thigh
and leg; Syme and Chopart’s operation; metatarsus and
toes 211-215
THE
ESSENTIALS OF BANDAGING,
&c.
CHAPTER I.
BANDAGING.
GENERAL RULES.—Ordinary bandages are strips of unbleached calico
6 or 8 yards long, having a breadth of ¾ inch for the fingers and
toes, 2¼ inches for the head and upper limb, 3 inches for the lower
limb, and 6 inches for the body. These, when tightly rolled for use,
are termed rollers. Besides these rollers for general use there are
special bandages, such as rollers of muslin for using with plaster
of paris, of stocking-webbing when elasticity is needed; four- and
many-tailed bandages for particular fractures, &c. Messrs. J. & J.
Cash, the cambric frilling makers of Coventry, now make a very firm
light bandage of unbleached cambric woven in the necessary widths
and lengths for use; these are very cool and pleasant, and a decided
improvement on the ordinary calico strips generally used.
_Position of the Operator._—He should place himself opposite his
patient, not at the side of the limb to be bandaged; the limb too
should be bent to the position it will occupy when the bandage is
completed.
Before applying any kind of apparatus, the surgeon should see that
the limb is carefully washed and dried.
_How to hold a Roller._—When applying a roller it is best to begin
by placing the outer surface of the roller next the skin (see fig.
1, page 3), for it then unwinds more readily, and the first turns
are more easily secured; moreover the bandage should be carried from
the inner side of the limb _by the front_ to the outer side, for
the muscles are thus more firmly and pleasantly confined than by
turns passing in the opposite direction; of course this observation
supposes the hand and forearm to be in their usual position of
semi-pronation.
_Varieties of Turns._—In carrying a bandage up a limb, it is
necessary, in order to support the parts evenly, to employ a
combination of three different turns. The _simple spiral_, _reverse_,
and the _figure of 8_.
The _simple spiral_ turn is used only where the circumference of the
part increases slightly, as the wrist; but when the limb enlarges too
fast to allow the fresh turn to overlap the previous one regularly,
the turn must be interrupted, and the bandage brought back again by
reverse, or by figure of 8.
To _reverse_ the bandage, the thumb of the unoccupied hand is placed
on the lower border of the bandage while the roller is turned over in
the other, and then passed downwards to overlap and fix the previous
turn evenly. At the moment of reversing, the bandage should be held
_quite slack_, and not unrolled more than is necessary to make the
reverse. All the reverses must be carried one above the other along
the outer side of the limb, and only employed where really necessary.
_Figures of 8_ are made, as their name implies, by passing the roller
alternately upwards and downwards as it enwraps the limb (see fig.
1). They are adopted where the enlargement is too great and irregular
for reverses to sit evenly, over the ankle and elbow joint for
instance.
[Illustration: Fig. 1.—Figure of 8 turn.]
THE HEAD.
=Bandages for the Head.=—A roller is commonly applied in three
different ways to the head. 1st. For keeping simple dressings in
place.
_Apparatus._—1. A roller 2 inches wide, and of the usual length.
2. Some pins.
A turn is first carried round the head, over the brows and below
the occipital protuberance, and fastened by a pin; this being done,
the roller is carried across the dressing, and getting into the
line of the first turn, is passed round the head again, then across
the dressing, and round the head by horizontal and oblique turns
alternately, the former to fix the latter, and prevent their slipping
off the dressing (see fig. 2). In the figure the oblique turns have
been doubled, and would fix dressings on each side of the head.
=Knotted Bandage.=—This is used when pressure on the superficial
temporal artery is required.
_Apparatus._—1. A roller 8 yards long, 2 inches wide, one-third being
rolled into one head, the rest into another head.
2. Some lint.
3. A piece of a wine cork one-third of an inch thick.
4. Needle, thread, and pins.
[Illustration:
Fig. 2.—Bandage for retaining dressings in position, showing two
sets of oblique turns.
]
The cork is folded in a double thickness of lint; over this are
placed six or eight more folds of lint of gradually increasing size,
and the whole are kept in shape by a stitch passed through them and
through the cork. This forms a _graduated compress_, and is then laid
on the wound small end downwards.
One head of the roller is taken in each hand, its middle laid over
the compress on the injured temple, say the right; the ends are
carried round the head, one just above the eyebrows to the left
temple, and the other backwards below the occipital protuberance, to
the same point; the ends are then crossed and changed from one hand
to the other to be brought to the wounded temple. Here they are again
tightly crossed, one end being carried under the chin and by the left
side to the vertex, there meeting the other end, which has passed
over the head, in the opposite direction (see fig. 3); at the right
temple the ends are again crossed or “knotted,” but this time they
are passed horizontally round the head. Having done this the ends
are pinned and cut off, or if necessary the knots repeated before
fastening; the first pair, if tightly drawn, usually suffice as well
as several.
[Illustration: Fig. 3.—Knotted Bandage.]
=The Capelline Bandage= is rarely required, but is used when the
restlessness of the patient renders it difficult to keep dressings or
ice-bags in place.
_Apparatus._—1. A double-headed roller, 2 inches wide and 12 yards
long.
2. Some pins.
[Illustration: Fig. 4.—Capelline Bandage.]
The middle of the roller is laid against the forehead just above
the brows, and the ends passed behind the occiput, where they are
crossed, and while one continues the circular turns round the head,
the other head of the bandage is brought over the top along the
middle to the front, passing under the encircling turn, which fixes
it. It is then carried back to the occiput, on one side of the first
transverse band, when again fixed behind by the circular band it
is brought forward on the opposite side of the first, and fixed in
front. This arrangement is repeated until the head is covered in a
closely fitting cap (see fig. 4).
In beginning this bandage, it is necessary to keep the first circle
low down, close to the brows in front, and below the occipital
protuberance behind, or the cap will not fit firmly over the skull.
=A Shawl Cap= is readily improvised with a silk or cambric
handkerchief folded diagonally into a triangle; the base of the
triangle is then carried over the brow, the apex let fall behind the
occiput, where the ends cross, and catching in the apex, come round
to the front to be tied on the forehead.
[Illustration: Fig. 5.—Shawl Cap.]
=The Four-tail Bandage.=—Instead of applying the handkerchief in
the manner just described, it may be split from each end to within
six inches of the middle, and so converted into a broad four-tail
bandage; the middle is laid on the top of the head, the hinder ends
tied under the chin, and the forward ones behind the nape of the neck
(see fig. 6). Or a piece of calico, 1½ yards long and 4 or 6 inches
wide, is split from each end 3 inches short of the centre—one pair
of tails being rather wider than the other. If used on the face, the
middle is put against the point of the chin, the two narrow tails are
carried backwards to the nape, crossed, and pinned together on the
forehead above the brows. The two broader tails are carried upwards
in front of the ears, where they turn round the two narrow tails, to
be either tied or pinned at the vertex. Four-tail bandages are used
elsewhere, as in the axilla, to keep poultices in place, &c.
[Illustration: Fig. 6.—Four-tail Bandage.]
=To retain Ice Bladders on the Head.=—This is done by folding a thin
napkin over the bladder, which is then laid against the head or part
to be kept cool, and the ends of the napkin are pinned tightly down
to the pillow at each side. In this way the bag cannot slip, and its
weight is at the same time prevented from pressing on the head.
=To compress the Jugular Vein after bleeding.=—After venæsection of
the external jugular vein it is requisite to keep a compress of lint
on the wound. This is done by fastening the bandage on the neck with
two simple turns, then carrying it in a figure of 8 round the neck,
over the compress and under the axilla of the opposite side, then
round the neck again; if the figure of 8 is passed pretty firmly,
sufficient pressure is made in this way without interfering with the
circulation through the vessels, and the turns round the neck of
course must not be tight.
THE TRUNK.
=To bandage the Breast.=
_Apparatus._—1. A roller 3 inches wide and 8 yards long.
The roller is first carried once round the body below the breast,
beginning in front and passing towards the _sound_ side. When the
bandage is fixed, the roller ascends over the lower part of the
diseased breast, to the opposite shoulder, and comes back by the
arm-pit to the horizontal turn; it is then passed round the chest
to fix the oblique turn. Having done this, it again is carried up
over the breast and shoulder, and round the body in alternate turns
until the breast is fully compressed, each turn over the breast being
carried higher than the preceding one, and each turn round the body
overlapping the oblique turn to keep it in place (see fig. 7).
[Illustration: Fig. 7.—Bandage for a Breast.]
=To bandage both Breasts.=—This is readily done by first bandaging
one breast and then, carrying the roller over the shoulder of the
side already bandaged, bringing it across the sternum and under
the second breast on to the horizontal turns, which it follows
alternately with the oblique ones, as was done in bandaging the
first breast. The only difference is, that in compressing the first
breast the bandage was passed obliquely upwards, for the second it is
carried obliquely downwards over the breast.
=Spica Bandage.=
_Apparatus._—1. A roller or 2½ or 3 inches wide.
2. Some pins.
Lay the end on the groin to be bandaged, carry the roller between the
great trochanter and the crista ilii round the pelvis to the other
side, passing there also between the crista ilii and trochanter;
next take the roller downwards in front of the pubes to the injured
groin, then outwards round the thigh below the trochanter to the
gluteal fold, and pass it up between the thighs to the groin, where
the figure of 8 is completed. A second and a third are to be passed
in the same way, carrying them exactly one over the other, round the
body and below the buttock (see fig. 8); at the groin they should
overlap, each lying a little above the preceding turn. A pin, when
the necessary number of turns is completed, fastens down the end.
[Illustration: Fig. 8.—Spica for the Groin.]
=Hernia Spica.=—The spica bandage is usually required to keep
dressings and compresses in place over wounds after operation for
strangulated hernia, sinuses, &c., in the groin; when the figure of
8 has been put on the first time it may be cut across in front; and,
the dressings being changed, the ends may be fastened together by
pins. If additional strips are laid across and fastened to the figure
of 8 underneath, the required pressure is obtained, and much tedious
lifting of the patient is saved (see fig. 9.)
[Illustration: Fig. 9.—Hernia Spica.]
=Body bandage for tapping the Belly in Ascites.=—This is made of two
thicknesses of stout flannel, 2 feet wide in the middle, where it
forms a continuous sheet for 18 inches, but beyond that it is split
into 3 tails, 6 inches wide and 3 feet long. In the middle line, 4
inches below the centre, is a round hole 2 inches across, through
which the surgeon reaches the skin to insert the trocar.
When in use, the middle of the bandage is placed in front with the
hole in the mesial line of the body, and midway between the umbilicus
and pubes; the ends of the right side are passed behind the back to
the left, interlacing with those from the left side. When all is
ready, an assistant standing on each side of the bed pulls steadily
on the ends to keep up continuous pressure on the abdominal viscera
as the fluid escapes. After the fluid is evacuated the ends are
wound firmly round the body in front, while the puncture in the wall
of the belly is closed by a fold of lint attached with a strip of
plaster.
=The T Bandage= is used to apply dressings, compresses, &c., to the
anus or perinæum. A roller 3 inches wide is fastened by a couple of
turns round the pelvis, and then fixed by a pin at the middle line
in front. From this point the roller is carried tightly over the
dressings to the corresponding point behind, and returned once or
twice more until sufficient pressure is gained, when it is fastened
off.
=The Strait Jacket= is made of jean or stout canvas. It is cut long
enough to reach below the waist, around which a strong tape is
carried to be drawn tight and tied after the jacket is put on. The
sleeves are several inches longer than the arms, and their ends can
be drawn close by a tape which runs in the gathers; a similar tape
confines the garment round the neck, and it is tied behind by tapes
down the sides. When the jacket is to be put on a patient it is first
turned inside out, then one of the nurses or assistants thrusts his
own arms through the sleeves, and facing the patient, invites him to
shake hands; having thus obtained possession of the patient’s hands
he holds them fast while a second assistant, standing behind the
patient, pulls the jacket off the first assistant on to the patient,
whose hands are thus drawn through the sleeves before he perceives
the object of the manœuvre; the jacket is next tied round the neck
and behind, the tapes of the sleeves are carried round the body,
drawn tight till the arms are folded across the chest, and fastened
to the bed on each side, or tied round the body.
_Manacles for Delirious Patients._—Instead of the strait jacket
a double leathern muff is now generally used to restrain unruly
patients. It irritates them less, and is far more easily applied.
[Illustration: Fig. 10.—Manacles for confining the arms of delirious
patients.]
In wearing it the arms are crossed in front, and a strap drawn
tight round both wrists. Each hand is thrust into a stout leathern
glove, or muff, connected with the wrist-strap, and capable of being
tightened over the fingers by a strap and buckle across the glove.
=To suspend the Testicles.=—Suspensories are made specially for this
purpose. The best are fastened round the neck by a loop of elastic
tape, but a very efficient one can be improvised with a pocket
handkerchief and a piece of bandage. The bandage is tied tightly
round the hips for a girdle, the handkerchief is folded three-corner
wise, and its longest side slipped behind the testes, the ends being
passed over the girdle (see fig. 11), and tied again behind the
scrotum. The loose apex of the handkerchief is drawn up in front over
the girdle and pinned to it, which is all that is required (see fig.
12).
[Illustration:
Fig. 11.—Shawl Suspensory for the Testes, in the first stage of
application.
]
[Illustration: Fig. 12.—Suspensory for Testes completed.]
When the patient is recumbent, the testes may be supported by a
strip of diachylon plaster 2 feet long and 4 inches wide, passed
across from hip to hip underneath the scrotum and testes, which lie
supported on a shelf.
Another way of raising the testes is to place a soft pincushion
between the thighs, and allow the swollen gland to rest on the
cushion.
UPPER EXTREMITY.
=Bandage for the Fingers and Thumb.=
_Apparatus._—A ¾-inch wide roller.
_The fingers_ are bandaged to prevent œdema when splints are tightly
attached to the fore or upper arm. A roller ¾ inch wide is passed
once round the wrist and then carried over the back of the hand to
the little finger; then wound in spirals round it to the tip and
returned up the finger, completed by a figure of 8 round the wrist
and the root of the finger, and returned to the wrist before being
brought across the back of the hand to the next finger, to which it
is applied in the same manner till the four fingers are covered.
It is a good precaution to place a shred of cotton wool between
each finger before carrying the figure of 8 turn round the root; it
prevents the bandages from chafing the tender skin.
_The thumb_ is bandaged rather differently: the roller is commenced
in the same way round the wrist, but the first turn is carried at
once beyond the last joint, turned once or twice round the last
phalanx, and continued by reverses to the metacarpo-phalangeal joint;
the ball of the thumb is then covered by figures of 8 round the thumb
and wrist. This is called the _spica for the thumb_.
[Illustration: Fig. 13.—Spica for the Thumb.]
This plan is sometimes employed to compress bleeding wounds of the
ball of the thumb, and is applied without previously covering the
phalanges, as in fig. 13.
=The Hand and Arm.=
_Apparatus._—1. A roller 2¼ inches wide for an adult, but narrower
for a child.
2. Some cotton wool.
A little cotton wool should fill the palm before applying the roller.
The bandage commences with figures of 8 carried round the hand and
wrist. The roller is first passed across the back of the hand from
the radial border of the thumb to the root of the little finger (see
fig. 14), and then across the palm, reaching the back of the hand
between the thumb and forefinger.
[Illustration: Fig. 14.—Commencing to bandage the hand.]
When the hand is covered by these figures of 8 the bandage is passed
up the _forearm_ by reverses placed over the extensor muscles till
the elbow is nearly reached. Before going further a dossil of cotton
wool is placed in the bend of the elbow, and on the inner condyle;
the joint is bent to the degree that will be required by the splint,
and the patient told to grasp some part of his dress, or the sleeve
of the other arm, that he may not unconsciously extend the joint
again while the bandage is being rolled round it.
_The elbow_ is covered by first carrying the roller round the joint,
so that the point of the olecranon rests on the centre of the turn
(see dotted lines, fig. 15). The bandage is then continued in figures
of 8, passing above and below the first turn until the elbow is
covered in and the bandage of the forearm is completed.
[Illustration:
Fig. 15.—Bandage covering the elbow. The first turn over the point
of the elbow is shown by the dotted lines.
]
[Illustration: Fig. 16.—Spica Bandage for the shoulder.]
_The arm_ is covered by spirals and reverses till the armpit is
reached. Before bandaging _the shoulder_ the armpit is protected by
cotton wool or a double fold of soft blanket; the roller is then
carried in front of and over the shoulder, across the back to the
opposite axilla, where also some wool should be placed, then across
the chest to the top of the shoulder again, and under the armpit to
the front (see fig. 16). These figures of 8 are repeated as often as
necessary to complete the covering. The bandage is applied in this
method for dressings; but when pressure is needed the first turn may
be carried at once to the root of the neck, and each succeeding turn
made to overlap below the last, until the point of the shoulder is
gained, as in fig. 37, p. 55. These are called _the spica for the
shoulder_.
=Wound of the Palmar arch.=—Bleeding from this wound can usually
be stopped by pressure on the bleeding point, when this fails an
attempt should be made to tie the vessel at the wound, and if this be
impracticable the arteries of the forearm must be deligated.
_For compression_ the following is necessary:—
_Apparatus._—1. Petit’s tourniquet.
2. Straight wooden splint.
3. Rollers 2 inches wide, and ¾ inch wide for fingers.
4. Pad and cotton wool.
5. Lint.
6. A slip of a wine cork.
7. Scissors and needle and thread.
8. Lunar caustic.
Step 1. First apply the tourniquet to the brachial artery, to control
the hæmorrhage while the apparatus is being adjusted.
Step 2. Make a graduated compress by folding a sixpence or slip of a
cork in two or three thicknesses of lint, trim the lint into circular
disks and prepare a dozen similar disks of increasing size; lay these
one on each other to form a round cone about one inch high with the
piece of cork at the apex, and fasten them together by a thread.
Step 3. Clean and dry the wound, then rub its surface carefully with
nitrate of silver, to lessen the suppuration.
Step 4. Bandage the fingers and thumb, and prepare the splint, which
should be straight, as broad as the forearm, and long enough to
reach from the elbow to the tips of the fingers; it should be lightly
padded.
Step 5. Envelope the wrist with a little wool; next lay the graduated
compress on the wound, the small end downwards, and press it firmly
in with the left thumb, while the splint is applied to the back of
the hand and forearm. These are then fixed by a roller carried in
figures of 8 round the hand and wrist across the compress until that
is tightly pressed into the wound and the splint fixed to the limb.
The roller is then carried along the forearm, a fold of wool laid in
front of the elbow, the tourniquet removed and the roller carried to
the axilla while the forearm is raised, flexed across the chest, and
fastened to the side.
This apparatus is worn without being disturbed for three or four days
if bleeding do not return; but at the end of this time it should
be examined; if painful or if discharge ooze out at the wound, the
bandage should be removed and readjusted less firmly than before, a
piece of wet lint replacing the graduated compress.
=Venæsection.=—Bandage and bleeding at the _bend of the elbow_.
_Apparatus._—1. Lancet.
2. Tape.
3. Pledget of lint.
4. Dish.
5. Staff.
In opening a vein at the bend of the elbow, the median basilic is
selected, simply because it is usually the largest, but any branch
that is superficial, and well filled with blood, may be opened.
The patient should sit or stand, in which positions, syncope, one of
the objects of bleeding, is attained by the abstraction of a less
amount of blood than in the horizontal posture.
The surgeon places a graduated bleeding dish on a chair or stool
within his reach, and a pledget of lint in his waistcoat pocket; he
next gives the patient a heavy book, or staff to grasp in his hand.
The arm being bare to the shoulder, a tape, ¾ inch broad and 1¼ yard
long, is tied round the arm tight enough to impede the venous, but
not the arterial flow.
The surgeon standing opposite his patient and grasping the arm to
be bled with his left hand, so that his thumb controls and steadies
the swollen vein, takes his lancet between the right forefinger and
thumb; then going through skin and vein at one stroke, carries the
lancet upwards for about ¼ inch along the vein. The puncture of the
lancet should be quite vertical, and the extraction also made quite
vertically, that the slit in the vein may correspond to the slit in
the skin.
This being done, the operator lays aside his lancet, and takes up the
dish, holding it so that the blood shall flow into it: when the dish
is placed, he lifts his left thumb from the vein cautiously or the
sudden spirt of blood will fall outside the dish and be lost. When
the desired amount is drawn, the operator compresses the vein again
with the left thumb, and setting down the dish, puts the pledget of
lint over the wound. He keeps the pledget in place with his left
thumb, while he releases the tape round the arm and places its middle
obliquely across the pledget. His left thumb presses the pledget on
the wound, while the right hand takes the end of the tape which is
farthest from his left, and passes it under the forearm below the
elbow to his left fingers, which grasp it tightly. He then takes the
other end with his right hand (see fig. 17), and bringing it round
the arm above the elbow, carries it across the pledget: as he does
this, he replaces his left thumb on the compress with his right
forefinger, which he keeps there while he brings up the end of the
tape he has already in his left fingers, and throws it over the arm
_above_ his right forefinger, then passing his left hand _below_ the
right forefinger, he catches the same end of the tape again and draws
it back. The two ends thus locked in a loop over the compress, are
secured by tying them in a bow outside the elbow and the operation is
finished (see fig. 18).
[Illustration: Fig. 17.—Adjusting the tape after bleeding.]
[Illustration: Fig. 18.—The bandage completed.]
THE LOWER EXTREMITY.
For adults the most useful width for the rollers is 3 inches, and the
length the ordinary one of 8 yards.
=The Foot= is usually bandaged without covering the heel, and the
bandage is begun as follows:—
The roller being held in the right hand for the right foot, or in
the left hand for the left foot; the unoccupied hand takes the end,
and passing it under the sole, brings it up on the back of the foot
just behind the toes, where it is made fast by carrying the roller
outwards over the back. When one turn is completed, the bandaging is
continued by reverses until the metatarsus is covered, then one or
two figures of 8 round the foot and ankle carry the bandage to the
leg, where it proceeds upwards by spiral turns round the small of the
leg, and by reverses up the calf. The reverses lie at equal distance
up the leg, on the muscles, not over the bone, that the skin be not
pinched between the crease of the bandage and the bone. When the calf
is passed, the roller is continued by figures of 8 above and below
the knee, until that joint is covered in, then by reverses up the
thigh to the groin, where the bandage terminates by a spica round the
body (see page 9). This is the ordinary bandage for the lower limb.
There are some varieties for particular parts, these are:—
=To cover the Heel.=—Holding the roller as for the foot, pass the end
behind the heel, bring it out by the outside over the front of the
ankle-joint, and complete the turn with the roller. In doing this,
the point of the heel must catch the middle of the bandage. If the
foot is a long one, the roller should be three inches broad; but a
narrower bandage is more easily fitted on a small foot. After the
first turn, the bandaging is continued by carrying the roller in
figures of 8 round the foot and ankle, passing alternately above and
below the first turn until the ankle is covered as in fig. 19.
[Illustration: Fig. 19.—Covering the Heel.]
=To bandage a Toe.=—Take two turns round the foot, with a bandage one
inch wide, then go round the toe to be raised, and back again round
the foot. This figure of 8 lifts a toe above the rest if taken from
the dorsal, and depresses it if taken from the plantar surface.
=The Knee is bandaged= by beginning with a simple turn round the leg
above the calf, then carrying the roller across the patella to the
thigh above the knee: and next entwining it in a circular turn round
the thigh before descending over the patella to the leg below the
knee, where this is repeated until the knee is covered.
=To bandage a Stump.=—The flaps are first supported by two or more
strips of plaster, one inch wide and ten or twelve long, carried from
the under surface of the limb over the face of the stump, and a slip
of wet lint and oilskin is applied to the wound. The muscles and soft
parts are next confined by a bandage. This is first fixed by simple
turns below the nearest joint, and brought downwards in figures of 8
round the limb till the end of the stump is reached, which is next
covered in by oblique and circular turns carried alternately over
the face of the stump and round the limb, as is shown in fig. 2 for
bandaging the head. Or, if a double-headed roller be used, in the
manner directed for the capelline bandage on page 5.
=Extending a Stump.=—When the soft parts fall away from the bone
they may be drawn down by attaching a weight by cord and pulley, as
described for extending the hip-joint (see fig. 80). The stump should
be lightly bandaged and the cord fastened to its upper and under
surface. The weight is very small at first, and should be increased
from time to time as required.
=Many-tail, or 18-tail Bandage=, or bandage of Scultetus.—A roller is
cut into short lengths long enough to encircle the limb and to let
the ends overlap 2 or 3 inches; these are applied separately, the
lowest first, the next overlapping it, and the next overlapping the
second until the requisite number are applied. Sometimes the tails
are attached to each other before they are applied. To do this, the
tails are laid out on a table, so that the second overlaps one-third
of the width of the first strip, and the third strip overlaps the
second, and so on. When all the tails are arranged, a strip is laid
across their middle and fastened to each tail by a stitch; but this
is not a necessary part of the bandage, and it prevents single tails
from being removed. This bandage is used in compound fractures and
other wounds, as the soiled strips can be replaced without raising
the limb to pass the roller under it.
=Elastic Socks and Stockings= are made to support varicose veins of
the legs. They are woven of india-rubber webbing with silk or cotton.
The latter are the lowest priced and often even the most comfortable
to wear. The stockings should fit carefully everywhere, especially at
the small of the leg, where they generally are too slack, while they
cut at the upper end below the knee.