> *t:K\v*$£~j-*:~-: ■"■■■■ Ys-y ■■■■i 1*5* >y> «»3 •v ;j.•■-.\--^4%^,vA-u-',f-aj5^-■"■"?..•■-■-- ■■■ ^ ■■;■ 'fe^\#-: %:•> :-:vv .■.--#■•*,». A', v-v'*:-:' --.*• sap*? ^™ .^^''•^'V.''■- -" - '- • • '' - -1 - - I ^Vs^ST'' '-^C**v '•' '-"-** "■ ^ ■ .w ■:<■' *r: • •' - A - 'X + ^^^^A^;'x;vr ■:*■■:••;.■■•;•: < JO Aavaan ivnoiivn 3noic33w jo Aavaan ivnoiivn 3nidiq3w jo Aavaan ivnoiivn LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE n jo Aavaan ivnoiivn 3noiq3w jo Aavaan ivnoiivn 3NOI03W jo Aavaan ivnoiivn 3nid 5 \smm-' q vfftix/ 2 a. L LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE ■o \ a. v jo Aavaan ivnoiivn 3noiq3vv jo Aavaan ivnoiivn snidiqsw jo Aavaan ivnoiivn ,L LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE w jo Aavaan ivnoiivn snoiqsw jo Aavaan ivnoiivn 3nidiq3w jo Aavaan ivnoiivn ,L LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATI w jo Aavaan ivnoiivn 3nidiq3w jo Aavaan ivnoiivn snoiqsw jo A.-vaai'' 'won* □ 'hShOlSOQ U1N ,1 LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDlC'lNE A NLM005604540 I3w jo Aavaan tvnoiivn SNtDiasw jo Aavaan ivnoiivn snoiosw jo Aavaan tvnoilvn 3n JAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA < A 33w do Aavaan ivnoiivn 1 3NOia3w jo Aavaan tvnoilvn jnoiojw jo Aavaan tvnoilvn 3n -IAL LIBRARY OF MEDICtNE < A nw jo Aavaan tvnoilvn 1 NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA o a. I 0 *■---- n ■* 0 SNOiasw jo Aavaan tvnoilvn 3noiq3w jo Aavaan tvnoilvn sni 1AL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA1 NAl w 3w jo Aavaan tvnoilvn 3Nt3ia3w jo Aavaan tvnoilvn 3noici3vv jo Aavaan ivnoiivn 3ni -a 5 XXOJSiK o ^Ul/\ S M LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA A' .< 3w jo Aavaan tvnoilvn snidiqsw jo Aavaan tvnoiivn 3NOta3w jo Aavaan ivnoiivn 3ni o / AL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA' A MANUAL BANDAGING. ADAPTED FOR SELF-INSTRUCTION. By C. HENRI LEONARD, A. M., M. D., v M Professor of the Medical and Surgical Diseases of Women, and Clinical Gynaecology, Detroit College of Medicine; Member of the American Medical Asso- ciation; of the Michigan State Medical Society; of the Wayne County Medical Society; and Honorary Member of the Canada Medical Association. ft&ttli (Site JPmtbteb atrb Cl/trftr-ftme d&ngrabmgs. SIXTH EDI TI PUBLISHED BY THE ILLUSTRATED MEDICAL JOURNAL CO., DETROIT. Bandaging Copyrighted 1875 and 1884. fhe Illustrate! Medical J0™' Company's OTHER PUBLICATIONS. FOTHERGILL'S BRIEF TREATISE ON THERA- PEUTICS; with Chapters on Diet and Care of the Sick, by a Hospital Matron. Cloth, lhO pages (hundreds of formulae and prescriptions). Post- paid, $1.00. LEONARD'S PHYSICIAN'S POCKET DAY-BOOK— Accommodates charges,for 50 patients daily for 13 months, besides other entries. Bound in maroon Russia, flap and pocket. Price, $1.00. LEONARD'S AUSCULTATION, PERCUSSION and URINALYSIS; an Epitome of the Physical Signs in Health and Disease, of the Heart, Lungs, Liver, Kidneys and Spleen. Cloth; 160 pages, kl Illustra- tions. Price, $1.00. LEONARD'S DOSE BOOK.—Contains doses of more remedies than any other Dose Book issued. Some 40,000 sold. Price, Cloth, 75c. Dose Book and Anatomist combined—Cloth, over 200 pages—$1.00. LEONARD'S ANATOMIST—Details each Bone, Ar- tery, Vein, Nerve, Muscle, etc., etc. 12,000 copies sold—2,000 to the students in Great Britain. Price, Cloth, $1.00 LEONARD'S MANUAL OF BANDAGING-Describes all classes and kinds of Bandages, Poultices, etc. 139 Illustrations. Text-book in several Colleges. Price, Cloth, Octavo, 160pages, SI.50. LEONARD'S, THE HAIR, ITS GROWTH, CARE. DISEASES, AND TREATMENT.—Fully Illustrated by over 100 Engravings. Price, Cloth, Octavo, 320 pages, $2.00. LEONARD'S PENCIL NOTE-BOOK.—Contains 400 pages pencil paper for note-taking of Medical Lec- tures, or for the Physician's table, besides several pages of useful printed matter. Price, board sides 30c PHYSICIAN'S OFFICE DAY BOOK (Leonard). For 25 families daily this book is good for 4 years; for 50 families daily, it is good for 2 years; for 100 families daily, it is good for 1 year. Name needs writing but once each month. Cloth, Leather back and Corners, post-paid, $2 00. LEONARD'S PHYSICIAN'S LEDGER.—The briefest method of keeping ledger accounts out. Good for 400 families yearly for 5 years. Price, Leather and Cloth, $2.50. LEONARD'S PHYSICIAN'S ACCOUNT-STATE- MEN IS.—Each contain your name, address, office hours, etc., and a stub for filing away. Price, two books, $2.50. CODES OF MEDICAL ETHICS.—Gives the Codes of the three schools of practice. Price, Paper, 25c. GLAZIER'S TRICHINJE AND TRICHINOSIS.—A brief though full history of the growth and symp- toms of the disease from this dread parasite. 17 Illustrations. Price, Paper, 25c. DISEASES OF THE NASAL CAVITY AND PHAR- YNX.—Translated from the German of Michel, by Prof. Yemans. This book has been highly com- mended by the press. Price, Octavo, Paper, $1.00. CLINICAL TABLETS. For keeping, twice daily, records of your cases ; in pads of 75 leaves, post- paid, 35c. For Gynecological Cases, for keeping a minute record of symptoms and results of ex- amination, in pads of 75 leaves, post-paid, 60c. *** Full Descriptive Circulars free on application, or any of the above sent post-paid on receipt of price by the publishers. THE ILLUSTRATED MEDICAL JOURNAL CO., Detroit, Mich. i^~Sold by all Medical Booksellers. PREFACE TO THE SECOND EDITION. Horace Greeley, in his " History of the American Conflict," wrote his preface under the caption of "Preliminary Egotism." This being of necessity the very nature of all book prefaces, the Author of A Manual of Bandaging would hereby acknowledge the pleasure he has received from the kindly reception awarded the first edition of his Book. Not only have Physicians, in private letters to Hie Author, commended the work very highly, but the Medical Press has been equally generous in its bestowal of praise. Prominent Professors in various Medical Colleges have also included it amon^ the text-bouks recommended to their stu- dents. To all of these kind friends the Author would now return his thanks. This second edition of the Manual has been enlarged by the addition of fully one-fourth of new matter, and new illustrations. The chapters most largely added to have been those devoted to the " Bandages of the Upper Extremity," "Bandages of the Lower Extremity," and "Im- movable Dressings;" though most of the other chapters have received additions of new matter and new illustrations as well. So, too, some of the old cuts have been discarded, and new and better ones have been put in their places. The general classification, and manner of description, as given in the previous edition, has been retained; this will be found fully described in the following Preface. To the various medical gentlemen who have assisted him in the prepa- ration of this new edition, by criticism and new matter furnished; and also the instrument house of John Reynders & Co., for the loan of cuts to illustrate the portion devoted to the description of Professor Sayre's " Spinal Apparatus," the Author would now tender his thanks, sincerely hoping this new edition of his book will be found as worthy of com- mendation as the first. C. H. L. Detroit, 80 Miami Ave. [3] PREFACE TO THE FIRST EDITION. In the issue of this little Manual the author has hoped to meet the wants of many students of medicine, and practitioners who have had no opportunities for hospital drill in bandaging. Our text-books, in general, are very meagre in their descriptions and illustrations of this branch of surgery, and our " Lectures," given upon this topic at our medical colleges, are too often cursorjr and incomplete, from the press of, seemingly, weightier matters that demand attention. We have, the author believes, no work in the English language that is. devoted exclusively to this subject. Several works upon "Minor Sur- gery," in reprints and original editions, are seen upon our book shelves; yet even these offer but few descriptions, and have fewer illustrations— really the essential part of all treatises upon this art—of the various ban- dages. In this work each bandage is designed to have an illustration of its application. There are but a few exceptions to this rule, and these all are either referred to a wood-cut that answers the purpose sufficiently well, or else the bandage is so exceedingly simple that none is required. It will be noticed, also, that but few " double-headed " bandages are given. It has been the purpose of the author to omit these so far as pos- sible ; thus making the book consist of the simple and more useful ban- dages, rather than those after the "fancy" and ornate order. A glance %at the Table of Contents will show the extent of ground gone over, and the completeness, or incompleteness of its consideration. "Knots," "Poultices," "Strappings/' and "Immovable Bandages,"are so intimately connected with the subject treated of at length, that it was thought advisable to introduce a few short chapters upon these topics. Gerdy's classification has been, in the main, followed for the Roller bandages, and Mayor's for the most of the Triangles and Cravats, though the autnor has adopted dressings from other sources as well. He is also under great obligations to Professor John H. Lowman, of the Medical Department of the University of Wooster, Cleveland, Ohio, for original matter and designs received, besides many other courtesies extended to him. Thanking his other various friends for advice and assistance given, he awaits with interest the Manual's reception by the medical public. C. H. L. January 1st, 1876. [4] CONTENTS. CHAPTER I. Cataplasm at a.—How to Make a Poultice. How to Spread a Poultice. How to Apply a Poultice. Medicated Poultices. Cataplasma Car- bonis. Cataplasma Conii. Cataplasma Fermenti. Cataplasma Lini. Cataplasma Sinapis. Cataplasma Sodae Chlorinatae. Cataplasma Panis et Lactis. Oakum Poultice...........Page 13 CHAPTER II. Charpie and Cotton-wool.—A Plumasseau. A Gateau. A Boulette. A Bourdonnet. A Tampon. A Pelote. Tents. . . . Page 18 CHAPTER III. Compresses.—The Square. The Graduated. The Triangular. The Rectangular. The Circular. The Complex. Those of Two, Three, Four, and Six Heads. The Button-hole. The Perforated. Page 21 CHAPTER IV. Bandages in General.—Maltese Cross. A Roller. How to Make, Apply and Confine a Roller...........Page 24 CHAPTER V. Classification of Bandages.—Simple Bandage. Compound Bandage. Regional Classification.............Page 30 CHAPTER VI. Bandages of the Head.—Skull Cap. Circular of the Forehead and Eyes. Four-tailed Bandage of the Face,. Fillet or Head-band. Triangle of the Face. Cross of the Eye. Triangle of the Eye. Cross of the Eyes. Fronto-oculo-occipital Triangle. Fronto-occi- pital Triangle. Occipito-frontal Triangle. Biparietal Triangle. Simple Cross of the Chin. Four-tailed Bandage of the Chin. Occi- pito-mental Triangle. Cross of the Head. Knotted Bandage of the Head. The T of the Head and Ear. The Perforated T of the Head and Ear. Occipito-auricular Triangle. Recurrent Bandage of the Head. Six-tailed Bandage of the Head. Triangle of the Head. Double T of the Nose. T of the Mouth. Invaginated Roller of the Upper Lip. Invaginated Roller of the Under Lip. Fronto- cervico-labial Triangle. Invaginated Triangle of the Under Lip. Posterior Cross of the Head and Neck. Four-tailed Bandage of the Head and Neck...............Page 32 [5] 6 CONTENTS. CHAPTER VII. Bandages op the Neck.—Circular of the Neck. Cervical Cravat. Posterior Figure of 8 of the Head and the Axillae. Double Poste- rior T of Head and Thorax. Fronto-dorsal Triangle. Anterior Figure of 8 of the Head and the / llae. Double Anterior T of the Head and Thorax. Occipito-stcrnal Triangle. Figure of 8 of the Head and Axilla. Parieto-axillary Triangle and Cravat. . Page 53 CHAPTER VIII. Bandages op the Upper Extremity.—Spiral of One Finger. Poste- rior Figure of 8 of the Thumb and Wrist. Posterior Figure of 8 of the Hand and Wrist. Anterior Figure of 8 of the Hand and Wrist. Four-tailed Bandage of the Hand. Double T of the Back of the Hand and Wrist. Single T of the Back of the Hand and Wrist. Perforated T of the Hand and Wrist. Carpo-digito-palmar Triangle. Double Anterior T of the Hand and Wrist. Single An- terior T of the Hand and Wrist. Carpo-digito-dorsal Triangle. Spiral of all the Fingers. Spiral of the Fingers and the Hand. The Sheath of the Fingers. Figure of 8 Extensor of the Hand upon the Forearm. Figure of 8 Flexor of the Hand upon the Forearm. Car- po-olecranon Cravat. Flexor Carpo-olecranon Cravat. Simple Spiral of the Forearm. Reversed Spiral of the Superior Extremity. An- terior Figure of 8 of the Elbow. Posterior Figure of 8 of the Elbow. Triangle of the Elbow. Four tailed Bandage of the Elbow. Cervi- co-ulnar Cravat and Triangle. Spiral of the Arm. Four tailed Ban- dage of the Shoulder. Large Oblique Triangle of the Arm and Chest. Triangular Front of the Forearm. Small Front of the Hand or Forearm. Posterior Double Figure of 8 of the Elbow and the Opposite Axilla. Sayre's Clavicular Plaster-Splint. Velpeau's Ban- dage........... Page 60 CHAPTER IX. Bandages op the Body.—Spiral of the Chest. Spiral of the Abdomen. Perforated Spiral of the Chest. Circular-quadrilateral of the Chest, and Dorsal-cervico-sternal Triangle. Circular-quadrilateral of the Abdomen, and the Dorso-cervico-sternal Triangle. Circular-quad- rilateral of the Thorax and Abdomen, and the Dorsal Cervico-sternal Triangle. Anterior Thoracico-scapular Triangle. Posterior Thora- cico-scapular Triangle. Figure of 8 of the Neck and Axilla. Cravat of the Neck and Axilla. Figure of 8 of the Shoulder and Opposite Axilla. Ascending Spica of the Shoulder. Simple Biaxillary Cravat. Compound Biaxillary Cravat. Cross of One Mamma. Porous Adhesive Cross of the Mamma. Triangle of the Mamma. Bourse of the Mamma. Cross of the Two Mammae. Bimammary Triangle. Posterior Figure of 8 of the Shoulders. Simple Dorsal CONTENTS. 7 Biaxillary Cravat. Compound Dorsal Biaxillary Cravat. Anterior Figure of 8 of the Shoulders. Simple Sternal Biaxillary Cravat. Compound Sternal Biaxillary Cravat.....Page 81 CHAPTER X. Bandages of the Lower Extremity: Spiral of one Toe. Figure of 8 of One Toe. Adductor Bandage of the Big Toe. Double T of the Toes and Ankle. Spiral of All the Toes. Figure of 8 of the Foot and Ankle. Spiral of the Foot. Triangle of the Foot. Four-tailed Bandage of the Instep. Four-tailed Bandage of the Heel. Sheath of the Foot. Posterior Figure of 8 of the Knee. The Popliteal Cra- vat. Anterior Figure of 8 of the Knee. Cravat of the Knee. Tes- tudo of the Knee. Spiral of the Knee. Four-tailed Bandage of the Knee. Sanborn's Splint for the Patella. Hamilton's Splint for Frac- tured Patella. Simple Spiral of the Leg. Simple Spiral of the Thigh. Figure of 8 Spiral of the Extremities. Figure of 8 Bandage of the Extremities. Triangle of the Leg. Four-tailed Bandage of the Leg. Reversed Spiral of the Inferior Extremity. Perforated Reversed Spiral of the Inferior Extremity. Recurrent for an Amputated Thigh, etc. Triangle for Thigh Stump, etc. Maltese-cross for Thigh- stump, etc. Caputina. Tarso-patellar Cravat. Tarso-crural Cravat. Tarso pelvic Cravat. Scapulo-tibial Triangle and Cravat. Sling of the Lower Extremity. Cross of the Groin. Descending Spica of the Groin. Trapezoidal T °f the Groin. Cruro-inguinal Triangle. Cruro-pelvic Triangle. Cruro-pelvic Cravat. Sacro-bi-crural Cravat. Double T °f the Perinseum. Simple T of the Perinseum. Perinseal Cravat. Sacro-pubic Triangle. Four-tailed Bandage of the Hip. Coxo-pelvic Triangle. Lumbo-scrotal Triangle. Bourse of the Scro- tum. Double T of the Trunk..........Page 97 CHAPTER XI. Immovable Dressings: The Bavarian Plaster Splint. The Common Plaster Dressing. Starch, or Plaster, Roller. The Silica Bandage. The Paraffin Bandage. Fenestrated Immovable Dressings. Remov ing Immovable Dressings. Treating Compound Fractures. Treat- ment of Hip-joint Disease. Sayre's Plaster Bandage for the Spine Jury Mast. Silica Jacket............Page 127 CHAPTER XII. Strappings: For the Foot and Ankle. For wounds. For a Testicle. For the Breast. For Extension of the Leg. New Extension Appara- tus. Strapping for Varicose ulcers. Adhesive Bandages for Retain- ing Splints. . General Directions for Medicated Plasters. . Page 144 CHAPTER XIII. Knots: The Surgeon's Knot. The Reef Knot. The Clove-hitch Knot. M. Gerdy's Extension Knot........... Page 154 LIST OF ILLUSTRATIONS. FIGURE page > 1 Perpendicular Section of a Graduated Compress, . . 21 ' 2 Compress of Two Heads,....... 22 3 Compress of Three Heads, =......22 4 Compress of Four Heads,.......22 5 Button-hole Compress,........23 6 Perforated Compress, ... ; .... 23 7 Maltese Cross, . ......25 8 A Roller......... 25 9 How to Make a Roller-head,.......27 10 Machine for Rolling Bandages, ...... 27 11 Applying a Roller,.........28 12 Confining a Roller, 29 13 Circular of Forehead and Eyes,......82 14 Fillet or Head-band,........33 15 Cross of the Eye,..........34 16 Cross of the Eyes, ......... 35 17 Fronto-oculo-occipital Triangle,.......36 18 Fronto-occipital Triangle,.......37 19 Simple Cross of the Chin......... 38 20 Four-tailed Bandage of the Chin,......39 21 Occipito-mental Triangle, . ,......40 22 Cross of the Head, . .......' 41 23 Knotted Bandage of the Head, ... 42 24 The T of the Head and Ear....... * . ' 43 25 Perforated T of the Head and Ear,......44 26 Recurrent Bandage of the Head.......45 27 Diagram of the Six-tailed Bandage of the Head, . 46 28 Six-tailed Bandage of the Head,.....' . ' 46 29 Triangle of the Head,........ 47 30 Double T of the Nose..... ' ' ' 48 31 T of the Mouth......... 49 32 Invaginated Roller of the Upper Lip, . .'.'.' 50 33 Fronto-cervico-labial Triangle, . . . .... 51 34 Posterior Cross of the Head and Neck, . . .".'.' 52 35 Posterior Figure of 8 of the Head and Axillae, . . . ' . 54 36 Double Anterior T of the Head and Thorax, . . ' . 56 37 Occipito-sternal Triangle,........57 38 Figure of 8 of the Head and Axilla, . . ... 58 39 Parieto-axillary Triangle and Cravat, . . ... 59 40 Spiral of One Finger.......' 60 41 Posterior Figure of 8 of the Thumb and Wrist, . ' 61 42 Posterior Figure of 8 of the Hand and Wrist, . . 62 43 Diagram for Double T of the Back of the "Hand and Wrist, . 63 44 Double T of the Back of the Hand and Wrist, \ . 64 45 Diagram of the Perforated T of the Hand and Wrist, . . 65 46 Perforated T of the Hand and Wrist......66 47 Carpo-digito-palmar Triangle,.......66 [8] LIST OF ILLUSTRATIONS. 9 FIGURE 48 Spiral of All the Fingers,..... 49 Spiral of the Fingers and the Hand .... 50 Figure of 8 Extensor of the Hand upon the Forearm, 51 Carpo-olecranon Cravat,...... 52 Reversed Spiral of Superior Extremity, 53 Anterior Figure of 8 of the Elbow, .... 54 Cervico-ulnar Cravat and Triangle, 55 Large Oblique Triangle of the Arm and the Chest, 56 Triangular Front of the Forearm, 57 Small Front of the Hand or Forearm, 58 Posterior Double Figure of 8 of the Elbow and Opposite Axilla, 59 Sayre's Clavicular Splint, 1st course,..... 60 " " finished, 61 " " " front view, 62 Velpeau's Bandage, .... 63 Spiral of the Chest, 64 Perforated Spiral of the Chest, 65 Circular-quadrilateral of the Chest, and Dorsal Cervico-sternal Triangle, . ........ 06 Anterior Thoracico-scapular Triangle, 67 Figure of 8 of the Neck and Axilla, 68 Figure of 8 of the Slioulder and Opposite Axilla, 09 Simple Biaxillary Cravat, .... 70 Compound Biaxillary Cravat..... 71 Cross of One Mamma...... 72 Porous Adhesive Cross of the Mamma, 73 Triangle of the Mamma, .... 74 Diagram of the Bourse of the Mamma, 75 Bourse of the Mamma,..... 76 Cross of the Two Mammae, .... 77 Posterior Figure of 8 of the Shoulders, 78 Simple Dorsal Biaxillary Cravat, 79 Compound Dorsal Biaxillary Cravat, 80 Anterior Figure of 8 of the Shoulders, 81 Adductor Bandage of the Big Toe, 82 Figure of 8 of the Foot and Ankle, 83 Triangle of the Foot,..... 84 Posterior Figure of 8 of the Knee. 85 The Popliteal Cravat,..... 86 Testudo of the Knee,..... 87 Four-tailed Bandage of the Knee, 88 Sanborn's Splint for the Patella, 1st stage, . 89 Sanborn's Splint for the Patella, 2d stage, 90 Hamilton's Splint for Fractured Patella, 91 Figure of 8 Spiral of the Extremities, 92 Figure of 8 Bandage of the Extremities, 93 Triangle of the Leg, 94 Reversed Spiral of the Inferior Extremit 95 Perforated Rjversed Spiral of the Inferior Extremity, 96 Recurrent for Amputated Thigh, .... 97 Triangle for Thigh Stump, 98 Maltese-cross for Thigh Stump, 99 Diagram for Caputina, 100 Caputina Applied, 101 Tarso-patellar Cravat, 102 Scapulo-tibial Triangle and Cravat, 103 Sling of the Lower Extremity, . 10 LIST OF ILLUSTRATIONS. FIGURE PAGE i04 Cross of the Groin,........118 105 Trapezoidal T of the Groin,.......119 106 Cruro-inguinal Triangle,.......120 107 Cruro-pelvic Cravat,.........121 108 Sacro-bi-crural Cravat,........121 109 Double T of the Permaeum,.......122 110 Sacro-pubic Triangle,........123 111 Coxo-pelvic Triangle,........124 112 Lumbo-scrotal Triangle,.......124 113 Bourse of the Scrotum,........125 114 Double T of the Trunk,.......126 115 The Bavarian Plaster Splint........128 116 Apparatus for Starch Roller-making,.....131 117 Watson's Shears-saw,........133 118 Swing for Compound Fracture of the Leg, .... 134 119 Walker's Extension Splints........135 120 Walker's Apparatus for Joint Troubles.....136 121 Stillman's Sector Splint, .......136 122 Stillman's Sector Splint Applied.......136 123 Sayre's Extension Apparatus,.......137 124 Sayre's Jury Mast,........138 125 Sayre's Jury Mast Applied,.......138 126 Walker's "Jury Mast" Modification, . . * . .142 127 Silica Jacket Divided.........142 128 Strapping for Foot or Ankle, . . . . . . .146 129 Strapping for Superficial Cut,......146 130 Strapping for Deep Cut,........146 131 Laced Strapping for Cuts,.......147 132 Strapping for Testicle,........148 133 Extension of the Leg,........149 134 New Extension Apparatus........151 135 Strapping for Varicose Ulcers,......152 136 Strappings for Retaining Splints,......152 137 (A) The Surgeon's Knot, (b) The Reef Knot, ... 154 138 The Clove-hitch Knot,........155 139 M. Gerdy's Extension Knot, . .... 156 A MANUAL OF BANDAGING, CHAPTER I. UPON CATAPLASMAtA. HOW TO MAKE A POULTICE. Linseed meal is the substance usually selected for the basis of cataplasmata. We find this meal in the shops in two forms: 1st, the "crushed;" 2d, the "ground." The former is fre- quently employed, though it is not as handy to use as the " ground," which is the finer, adheres less to the integument, and retains its heat the longer, and takes up a larger amount of water. A sufficient quantity of the meal having been measured out, pour upon it boiling water, in small quantities at a time, stir- ring the mass, meanwhile, thoroughly with a spatula or spoon. Keep adding the water till the mass assumes the consistency of thick cream; it is now ready for "spreading." HOW TO SPREAD A POULTICE. The batter of the poultice having been prepared, it is neces- sary to have a piece of thick cotton cloth, or linen, two or three inches wider than the surface you wish to cover with the cataplasm. Spreading this smoothly out upon a flat surface, you pour the batter upon it, and with a spatula you spread it, to a proper thickness, evenly over the cloth, having care that it does not come to within an inch or two of its edge. You then fold each edge of the cloth evenly over the edge of the applied batter, thus leaving a clean, neat margin to your cata- plasm, as well as effecting a sort of a confinement of the bat- ter to the cloth. You now spread a very thin piece of muslin (the thinner the better) over the whole surface of the poultice; [13] 14 MANUAL OF BANDAGING. this prevents any of the meal from drying upon your patient's person, and ensures him a neat, clean and comfortable dressing. Some surgeons, however, prefer a coating of sweet oil over the spread poultice-batter to the thin piece of muslin. This also keeps the meal from adhering to the skin. HOW TO APPLY A POULTICE. Everything being in readiness, the poultice is lifted from the table, and one end gently laid upon the tender and inflamed surface, and the remainder of the poultice suffered gradually to cover over the diseased member; with this little care you will often save your patient much needless pain and suffering, that would else be caused by " slapping " your dressing upon a tender and sensitive part. The same gentleness should be used in lifting a poultice; otherwise, from the quick relief of pres- sure, a severe throbbing pain will ensue. After the cataplasm has been properly placed, it, and a por- tion of the member, should be covered with a piece of oil-silk, thin table oil-cloth, or oiled muslin, and over this should be thrown a layer or so of flannel, or thin layer of cotton-wool, the whole, finally, being lightly confined by a proper bandage. The oiled silk, or muslin, serves a double purpose: that of con- fining the heat and moisture to the part, and of protecting the bed clothes, or clothing, from the water in the poultice-batter. MEDICATED POULTICES. The linseed-meal poultice, as just described, may be medi- cated with various substances, as occasion requires: Thus, if an anodyne effect is desired, sprinkle over the top of the poultice, when spread, a teaspoonful of tincture of opium, or a grain of morphine. If an astringent effect is desired, a little sulphate of zinc, or pulverized alum, should be dissolved in the water of which the batter is made. If a disinfectant action is wished, carbolic acid can be added to the water of which the poultice-batter is made. Other CATAPLASMATA. 15 medicines may also be incorporated in the water, as the occa- sion may seem to demand. CATAPLASMA CAMBOm8-(Charcoal Poultice). Formula.*—Take of wood charcoal, in powder, one-half an ounce; bread crumbs, two ounces; linseed meal, one and one-half ounces; boil- ing water, ten fluid ounces. After macerating the bread in the water for ten minutes before the fire, mix well, and then gradually add the linseed meal, and intimately incorporate this with the mass. To this add one- half the charcoal, stirring it well in, and then sprinkle the remaining charcoal upon the surface of the cataplasma, when spread. The bread is not a necessary ingredient of this poultice, though advised by the Pharmacopoeia. It is quite as well if dispensed with, and the poultice is so made by most American dressers. If the water is taken at the temperature, of boiling, as the Pharmacopoeia recommends, the poultice, when spread, is generally of as sufficient high temperature as the part can well stand. Should the poultice have become cool, however, it should be heated by placing upon a stove, hot-air or steam- pipes. Uses.—In a general way all poultices have the same use; that of retaining warmth and moisture to a part, thus accele- rating sloughing and the discharge of inflammatory products; also that of protecting the surface from the air, and changes of temperature. Besides these more general uses, each kind may have a specific purpose of its own, as in case of the poul- tice under consideration. A charcoal poultice is, in fine, an antiseptic and disinfective poultice. The Pharmacopoeia has recommended loood charcoal; animal is still better, as it has greater power for absorbing the infecting material thrown off in the slough. It prevents noisome odors from foul, or gangre- nous surfaces, by absorbing the gases. It must be frequently applied, and should be used in all cases of gangrenous ulcer- ation. * Note.—The Formulae of most of these cataplasms are taken from the British Pharm acopceia. 16 MANUAL OF BANDAGING. CATAPLASMA CONII—{Hemlock Poultice). Formula.—Take of powdered hemlock leaves, one ounce; linseed meal, three ounces; boiling water, ten fluid ounces. Mix the hemlock and meal intimately together, and then gradually add the water, con- stantly stirring. Uses.—As an anodyne dressing for cancerous and syphilitic ulceration. As there is danger of the drug being absorbed too freely from the wounded surface, the patient should be watched closely that no poisonous symptoms may arise. Opium and Belladonna may also be made use of in making these anodyne dressings, using them, however, in much smaller amounts than is recommended to be taken of the conium. CATAPLASMA FERMENTI—{Yeast Poultice). Formula.—Take of beer yeast, six fluid-ounces; wheat flour, fourteen ounces; water (100° F.), six fluid ounces. Mix the yeast with the water and stir in the flour, afterwards placing the mass before the fire till it rises. Uses.—As a sort of an anodyne poultice. The carbonic acid gas evolved has something of an anaesthetic effect upon the inflamed skin. It corrects the fetor of the discharges, and stimulates indolent ulcers. The dressing is not now much made use of. CATAPLASMA SINAPIS—{Mustard Poultice). Formula.—Take of powdered mustard-seed and linseed, each, two and one-half ounces; boiling water, ten fluid-ounces. Mix the linseed meal gradually with the water, and then stir in the mustard. Uses.—More especially as a rubefacient. The Pharmaco- poeia has directed that boiling water be used. It would be better not to employ water at so high a heat, as it deteriorates its rubefacient power in some varieties of mustard. The laity often make an addition of vinegar; but this is a mistake, in case the black mustard be used, as it defeats the very action it was put in to enhance. Care should also be had in the application of this rubefacient to the very young or very aged; for if left too long applied, epidermal sloughing may occur. CATAPLASMATA. 17 CATAPLASMA SOD^E CHLORINATE—(Chlorine Poultice). Formula.—Take of solution of chlorinated soda, two fluid-ounces; linseed meal, four ounces; boiling water, eight fluid ounces. Mix the linseed meal, gradually, with the water, then add the solution of soda, with, constant stirring. Uses. — This is properly a disinfectant application, and makes a most excellent dressing for foul and gangrenous ulcers. Carbolic, or, perhaps better, Salicylic acid, is a useful adju- vant to the common linseed, and bread-and-milk poultices, having both an antiseptic and disinfectant action, besides a therapeutical and anaesthetical one. Tar is also sometimes incorporated in these styles of dressings, and makes an import- ant ingredient in a certain class of eczematous cases. CATAPLASMA PANIS ET LACTIS—(Bread-and-Milk Poultice). Description.—Take the inside of a loaf of stale bread, crumble it well up in eight or ten ounces of sweet milk, and, after soaking a few minutes, let it come to a boil, and then stir in a bit of lard, or a few drachms of sweet oil. Uses.—As an emollient dressing. Anodynes may be added as suits the case. Is not a very commendable poultice, as, from the heat, etc., of the inflamed part, the milk soon becomes rancid. POULTICE OF OAKUM. Description.—Take a sufficient quantity of oakum, loosely picked, and place in a thin piece of muslin, and wrap loosely up, then immerse the whole in boiling water. It is then wrung out and covered by a thin layer of muslin, and is thus to be applied to the member diseased, with oiled-silk over it all. Uses.—As an antiseptic and absorptive dressing. The water may be charged with antiseptics or anodynes. CHAPTER II. ON CHARPIE—COTTON-WOOL. Of this there are four kinds, viz., raw, long, rasped and web- like. But one of these, the raw, is of moment. This is made by picking apart the threads of a piece of linen, each filament having a length from 2 to 3 inches; if they are too short, the filaments are apt to mat or lump together, and so render it unfit for the uses for which it was intended. A good article should be white, soft and light, and somewhat elastic. The difficulty of procuring a properly prepared charpie, and of keeping it free from matting has, at present, induced most surgeons to substitute for it clean cotton-wool. Charpie, or cotton-wool, is used in surgery to protect from irritation, to compress, and to slightly irritate, as well as tc maintain in equal temperature a wounded member: one of ita most common uses is, however, as an absorbent of the secre- tions from a wounded surface. For these multitudinous usex it is employed under the form of plumasseaux, gateaux, bou lettes, bourdonnets, tampons, pelotes, and layers, or lamince. A Plumasseau (a pledget)—is but a bunch of charpie which has been drawn, lengthwise, lightly through the fingers till the filaments of the mass are made parallel with each other, and the mass made of the same thickness and density throughout. It may be used as an absorbent of secretion, for slight com- pression, or for carrying medicaments to a wounded surface. A Gateau (a cake)—is nothing more or less than a large plumasseau, with the ends of the charpie folded into the centre of the mass. It is used more especially for compression, and for absorbing the secretions of the wound. A Boulette (a little ball)—is simply a ball of charpie, formed by rolling little masses of it in the palms of the hands. [18] CHARPIE— CO TTON- WOOL. ] 9 Boulettes should be soft, elastic and loosely made. Are used for cleansing, or as carriers of sundry medicaments. A Bourdonnet {a dossil or lump of lint)—is a small plu- masseau tied closely around the middle, giving it an hour-glass shape. Used as a compress, or as a slight tampon in cases of haemorrhage. Tampon (a, plug)—is a large bourdonnet and prepared in the same manner as the preceding. Other forms and varieties are in use; as the vaginal, rectal, etc. The two latter are, perhaps, best jjrepared from pieces of lint, 3 or 4 inches square, soaked in water, then introduced singly, and " crowded closely home." Sometimes, as in lithotomy, wounds of the rectum, etc., we wish to make strong lateral compression; here use a tampon formed over a female (metal) catheter, by fastening the slotted end of the instrument securely to the center of a piece of lint 8 or 10 inches square; introduce this into the wound, retaining the corners of the lint at the surface. When introduced, pack your charpie, or lint, or cotton-wool, closely around the shaft of the catheter, between it and the surround- ing piece of lint, till you get the requisite amount of compres- sion. This form of a tampon can be successfully used in these cases, as the lint (fastened to the catheter) prevents the escape of the charpie, or other packing substance, up the gut (in the case of rectal use), or beyond the point where pressure is desired to be made. A Pelote (a ball, or pin-cushion)—is formed by tying firmly a wisp of charpie in a piece of lint, giving it something the shape of an old-fashioned pin-cushion, as made over a broken lamp-stand. Uses: bound over the course of an artery, it serves to arrest, for the time being, the flow of blood through it. It also serves the purpose of a tampon in certain cases of haemorrhage. Tents—have also been made of charpie by taking the long fibres of it, doubling in the middle, and then crowding it into the woundo But in our day of sponge tents, and the laminaria digitata. such a use of it will not be thought of, save in a case 20 MANUAL OF BANDAGING. of emergency, when the manufactured tents are not at hand. The most of the above articles of dressing are now made from what is generally known as "surgeon's lint" (see Chap- ter III). Still, some surgeons prefer the charpie, or even oakum dressing, to any other. The oakum is preferable in case an antiseptic surgical dressing is desired. CHAPTER III. ON COMPRESSES. These are best made of the " surgeon's lint" cloth, as it gives a more smooth, even and regular pressure. Their forms and sizes are almost innumerable, the surgeon using what the exigencies of the case may demand ; yet, the following brief classification may prove of service. I start with the most simple : The Square.—Its name indicates its peculiarity of form ; it may be of a rectangular piece of the " surgeon's lint," folded in the middle to make a square, thus being double thickness; or, it may be built up of a succession of smaller pieces to a pyra- midal form, forming the graduated pyramidal compress. If each successive piece is of the same size as the first, it forms the graduated regular compress. In either of the two latter forms, it should be stiched, through and through, in two or three places, so as to prevent the pieces becoming displaced. Perhaps a simpler way of forming a graduated compress is the following : Cut quite a long piece of the " lint" of the width of the compress desired, then placing one end of the fragment flatwise on the table to the extent of the size wanted in a logitudinal direction, fold it over upon itself, reversing the motion of the hand, till you reach the initial edge of the first layer; here fold over again, reversing the motion of the hand, and so on. Fig. 1 will give an idea of the manoeuvres Fig. 1. indicated, as the compress is seen on an exaggerated perpendicular section, a is the initial, b, the final end. In this case some stiches will be needed to confine the folds securely. The Triangular and Rectangular are but modifications of the above, and need no further description. [21] 22 MANUAL OF BANDAGING. The Circular is, as its name indicates, a circular piece of " surgeon's lint." We have three varieties of the circular com- press: 1st, the clipped; 2d, the perforated; and 3d, the gradu- ated. The first is the ordinary kind, the edges being clipped inwards to a sufficient extent that it may lie smoothly on a part. The second variety admits of any modification desirable in the position, form, or extent of puncture or cut. The third is essentially formed in the same manner as the others of its class. The Complex.—Under this head all perforated and fenes- trated compresses, and those of two or more heads, are meant to be included, whether they are rectangular or square. A Compress of Two Heads is simply a common compress, with one end split at the centre, as you see in Fig. 2. Fig. 2. Fig. 3. Fig. 4. Ill One of Three Heads.—A common compress with one end split into three equal or unequal parts, as seen in Fig. 3. A Sling Compress is a common compress having each end split at the middle, as seen in Fig. 4. It is also known as a compress of four heads. A Compress of Six Heads.—This is a compress similar to one of three heads; the difference being that both ends are split into three equal or unequal parts. COMPRESSES. 23 The Button-hole Compress is one that has two or more slits through its centre, as seen in Fig. 5. The Perforated Compress is one that has been, as its name implies, filled with small perforations, either by means of a stylet, or small punch, or by having pieces snipped out by the scissors. Fig. 6 will give you an idea of this. Is especially useful as a dressing for a freely suppurating surface. Fig. 5. Fig. G. The Uses of these various compresses are still more varied than their multiplicity of forms. The demands of the case must be met, by the ingenuity of the surgeon, in devising some- thing appropriate; and, having a knowledge of these more generally used forms, he can choose the one that will be most subservient to his purpose, or modify it to suit the exigencies of the case. CHAPTER IV. ON BANDAGES IN GENERAL. Hippocrates has said that, in bandaging, there is a two-fold purpose to be kept in view, viz., " that which regards it while doing, and that which regards it ~vhen done. It should be done quickly, without pain, with ease, and with elegance; quickly, by dispatching the work; without pain, by being readily done; with ease, by being prepared for everything; and with elegance, so that it may be pleasing to the sight." There could, perhaps, be no more terse, yet comprehensive, rules to be kept in mind as regards bandaging than these offered by that great medical sage nearly twenty-five hundred years ago. And yet, how often, in the drill our students receive in their class-rooms, has this exercise been deficient both in the teacher and in the taught. Yet, to the surgeon, a smoothly, rapidly applied bandage, aside from its extreme usefulness, has an element of beauty about it that is not readily forgotten_ It begets confidence, too, in your patient, in his friends, and adds greatly to your professional reputation. Hippocrates appreciated this, and instructed his pupils thoroughly in the minutiae of the art. To-day it is almost wholly neglected, and even if spoken of at all, is dismissed as hurriedly as possible from the thoughts of faculty and students. Hippocrates further adds: "The form of the bandage should be suitable to the form and affection of the part to which it is applied. The force of the constriction should be such as to prevent the adjoining parts from separating, without com- pressing them much, and so that the parts may be adjusted and not forced together." He further adds, after treating of the subject quite exhaustively, that "the bandages should be clean, light, soft and smooth. The heads of the bandages should be hard, smooth and neatly put on." This, coming from such antiquity, and agreeing with the hospital experiences of the last twenty-three hundred years, should be enough to recom- mend it to your most earnest consideration. [24] BANDAGES IN GENERAL. 25 Maltese Cross. The Maltese Cross.—This is formed from a square piece of surgeon's lint, by cutting up from each corner two-thirds of the way towards the centre of the piece, giving you, when com- Fig. 7. pleted, the form seen in Fig. 7. Another way of forming it is, to double the square piece of lint at its middle, then, trans- versely to this fold, double it over again; this gives you four thicknesses of the lint. This done, cut diagonally across this small square, to a distance of two-thirds of the length of the diagonal, beginning at the four free corners of the folded lint. On unfolding, you will find you have a regularly and evenly made cross of this pattern. Uses.—Most generally employed in stump- and joint- dressings, as it readily adapts itself to all convex surfaces, the corners smoothly folding over each other, as it is applied. A Roller—is the term given to our common narrow bandage; probably because to be used, it must first have been rolled smoothly and nicely up. Fig. 8 shows you the bandage, or roller, as ready for use. The part a is known as the head ; the part b is the initial end. Fig. 8 is therefore a roller with one head, and is classed as a simple bandage. Rollers may be of either one or two heads, at pleasure. In case of the latter the second head is formed by rolling up the initial end (b, in the cut) the same as the head a has been rolled. However, as a double-headed has no advantage over the single-headed roller, save in the bandage known as "the recurrent of the head," and a few others, I shall dismiss it, with but few exceptions, from this work. A single-headed roller is much more easily applied, looks just as well, and, in most cases, even answers the purpose better. Our single-headed roller has, then, besides the initial end and head, a plane, c; an internal surface, c; an external sur- face; a superior and an inferior border. Fig. 8. 26 MANUAL OF BANDAGING. How to make a Roller.—Rollers are generally made of flan- nel. In some delicate operations where " heating " of the wound, or the contiguous surface, is feared, linen or cotton has taken its place. The two latter substances never apply so evenly or smoothly as the flannel, as there is little or no elasticity in them. On the contrary, both edges of a flannel roller will lie smoothly upon a part if properly applied—a result difficult to be obtained on the use of a linen or cotton roller; that is, if the surface be anywise irregular or uneven. Farther than this, the stimulus, from pressure to a part, that flannel often gives, through its quality of elasticity is a great desideratum in most cases that re- quire a bandage. Then, too, if the part should swell, the bandage gives; if the swelling be reduced, the bandage, in great measure, accommodates itself to this change, " support" thus being con- tinually kept up; two other important qualities that are lacking in the linen or cotton roller. Of course the two latter have a plea of " cheapness,"—of doubtful consideration, however, when the comfort (present and future) of the patient is at stake. Tearing the Bandage.—It would seem almost superfluous to speak of such a small affair; yet, if one has many bandages to roll, it is an important item to save as much time as possi- ble. Having, then, the cloth in its width as it comes from the store, notch it at the points that will give you the width of bandages desired; this done, give to an assistant each alternate strip, you holding the others in your hands. Then, with a long and steady pull, the whole bolt of cloth is divided, in a moment, into bandages of the widths desired. The flannel having been torn into proper strips, as regards length and width, one end is taken and doubled over eight or ten inches upon itself; this doubled portion again doubled upon itself, and this again upon itself, until it is in proper shape for "rolling," or winding. This is started by gently rolling the doubled portion between the palm of the hand and table, or knee, as the case may be, until three or four turns are taken; then the roll is grasped between the thumb and forefinger (the second finger assisting if need be) of the left hand, the external surface (Fig. 9) of the bandage being up. The unwound portion is grasped by the right hand and allowed to fall in between the BANDAGES IN GENERAL. 27 thumb and forefinger, as seen in Fig, .9. (Some surgeons prefer fig. 9 to have it fall in between the first and second fingers, the thumb crowding in closely to the " head " of the bandage.) This done, holding the band- age quite firmly, yet loosely enough to slip, between the thumb and finger, the thumb hugging tightly the " head," by a downward or supine motion of the right hand, you parti- ally circle the forming roller-head, the ring-finger sliding over it as a guide. This done, grasp the roller-head firmly with the right hand (by pressing it against the ball of the thumb with the second and third fingers), pronate the hand as far as pos- sible, then confide the grasp of the roller-head to the thumb and fingers of the left hand, to go through with the same manoeuvres as before. In all of these motions the left hand is to be per- fectly immovable, the right performing all the work, save the simple holding of the roller-head when the right is making its supination around it. Although beginning these motions slowly, you can soon increase their rapidity until you can "roll" a bandage with surprising quickness. As soon as the " catch " to it is mastered, it is easily and rapidly done. Fig. 10. 28 MANUAL OF BANDAGING. Instead of trusting solely to the hand-rolling of bandages some hospitals now make use of a rolling machine, similar to that shown in Fig. 10. In the cut there is shown the clamp, e, that fastens the whole firmly to the table. The bandage is fixed to the axle, a, being threaded beneath the bar, b. By hold- ing the bandage "taut" against the bar with the left hand, d, as the right hand, c, turns the crank to the axle, all wrinkles will be smoothed out from the bandage as it is rolled up. This makes a very handy and useful addition to the apparatus of the surgeon's office. How to Apply a Roller.—To be applied easily it must be wound evenly and tightly. Hippocrates said, "the turns of a bandage should be made from right to left, and left to right, except on the head, where they should be in a straight or verti- cal direction." I would simplify this by allowing the surgeon to suit his own convenience, remembering only to place the external surface of the initial end to the part to be bandaged. This done, press it firmly with the fingers of the left hand to the member; the right hand grasps the roller-head tightly between the thumb and first and second fingers, and carries it firmly down and around the member (letting it slowly unwind) as far as possible; then, grasping it with the left hand, the thumb of the right confining the initial end, complete the turn, overlapping the initial end completely or partially, as you see in turns 1 and 2 in Fig. 11. Make, then, one or two circular turns as 3 and 4, firmly and evenly sweeping around the limb, each overlapping the preceding course about one-third the width of the bandage. The " reverses," which should always be made whenever the part to be bandaged assumes any- thing of a pyramidal or conoidal con- tour, as they keep the bandage from slipping down, are formed by pressing the first and second fingers firmly upon the superior border of the bandage at the point where the reverse is to be made, thus securing the bandage; then, making a slack motion BANDAGES IN GENERAL. 29 of the right hand turn the bandage over, end for end, by the right hand fingers, and bring what was the superior border of the bandage down to the top of the left hand's finger, or fingers that arc confining the bandage; you thus make* an inferior of what was the superior border. Each succeeding reverse is to be made in the same way. There is also a " catch " to this, although simple as it may seem, that only repeated trials will enable you to become master of. The main points, however, to bear in mind, are: 1st. Keep the bandage always tight and with equal tension at every turn. 2d. Bring it up somewhat diagonally, before making the reverse, and carry it down diag- onally (the opposite of the other) after the reverse is made, as you see in the figure. 3d. Always have the edges of the over- lapping turn as nearly equal all around as possible; this is best done by keeping a " close eye " upon the upward and downward motions of the roller-head, and after a time this will be done unconsciously. The first few applications of a reversed roller should always be slowly and pains-takingly made, so that your hands may not learn some bad tricks that must be unlearned them before they will apply one smoothly and nicely. Festhixi lente is a good motto in bandaging. How to Confine a Roller.—To confine a roller properly is a nice point in the application of such a surgical dressing, although it is a manoeuvre that is too often clumsily and imper- fectly made. On reaching the terminal end of your bandage, always fold under the edges of the end, so as to bring it to the shape seen PV 12. in Fig. 12. Then introduce your pin (not perpendicularly but) in a direction contrary to the course of the bandage, as you see in the wood-cut. By so doing you will have it smoothly and securely confined. If the roller be very wide, two pins may be necessary. The "strain" on the bandage thus serves only to draw the pin into its place, and no ordinary amount of friction from the bed-clothes or wearing apparel will loosen it. CHAPTER V. CLASSIFICATION OF BANDAGES. In olden times bandages received their names from four sources, viz., 1st. Their authors. 2d. Their forms. 3d. Their uses. 4th. From some fancied resemblance to some article, or manoeuvre. t Thus we have the Hippocratic rhomb; the crooked nose; the hare ; the quadriga, etc., as epidetic terms frequently to be met with on persual of old authors. Nothing like a classifica- tion proper was attempted by them. Coming nearer to our own time, an attempt was made to put them all under the heads of their uses; such as " compressive," "retentive," " reductive," etc. But this utterly failed, as almost any bandage could be used for any of the special purposes for which the others were employed. Gerdy finally brought forward his system, that of referring all to some general figure, as "cross," "circular," "spiral," "figure of 8," etc., adding, as a generic cognomen, the part to which it was applied; as, " cross of the eye "; " cross of the head"; "spiral of the finger"; "figure of eight of the chest," etc. Mayor then produced his system of triangular and quadrilateral bandaging, naming them from the anatomical parts to which they were applied; a double name, in fact, the first being the part whereat the base of his triangle was applied, the other around or over which the ends were passed and fastened, e. g.; " occipito-frontal" would indicate that the base of his triangle was at the occiput, and the two ends of the triangle had been passed around and tied at the forehead. This latter system of nomenclature is really the more scientific; but it is hardly convenient to adapt it to our roller bandaging, the system most universally employed. The system of trian- gles and quadrilaterals of Mayor, though very convenient, will hardly come into general use, as it is impossible to get so [30] CLASSIFICATION OF BANDAGES. 31 smooth and nicely adjusted a triangle as a roller. In some cases, as for instance that of an exigency, it is well to under- stand his system; as by that you can adapt almost anything to the purpose until a better dressing can be procured. All bandages are divisible into two great classes, the simple and the compound. Under each of these are found many varieties, the prominent ones of which will be given under their respective heads. A Simple Bandage is understood to be of a single strip of flannel, or cotton, and may have one or two heads; may or may not be invaginated. In Mayor's system, a single triangle or quadrilateral, invaginated or not, comes under this division. A Compound Bandage can be briefly defined as a band- age made up of two or more pieces of flannel or cotton, whether in strips (rollers), triangles, cravats, or quadrilaterals; and may be invaginated, stitched (as a T)> or modified in any way that the surgeon may see fit. Besides these two general classes we have a regional classifi- cation; merely, however, for descriptive convenience, as the execution of a bandage is essentially the same in all parts of the body. These divisions are, 1st. Bandages of the Head. 2d. Bandages of the Neck. 3d. Bandages of the Upper Ex- tremity. 4th. Bandages of the Trunk. 5th. Bandages of the, Lower Extremity. This general plan of description I shall follow, giving first the roller bandages, belonging to the simple order, following each one with Mayor's that fulfill the same office; and lastly give those of the compound order, Mayor's triangles and cravats following those of Gerdy's system (the roller band- ages), as before. CHAPTER VI. • BANDAGES OF THE HEAD. SKULL-CAP. In all of the bandages of the head it is well to first apply a close-fitting flannel or cotton cap, known as a skull cap, to the head. It retains the bandage better in position, as it keeps the turns from coming in contact with the slippery and sliding hair. It will also be found full as comfortable to the patient, as it tends to keep the hair evenly distributed about the head, and so prevents its matting under different portions of the bandage. Pressure from the bandage is also more equalized. CIRCULAR OF THE FOREHEAD AND EYES. Description.—It should be three or four yards in length, and have a width of from one and one-half to two inches. Application.—Place the initial end 1 at or near the centre Fro. 13. °f the forehead, standing at the back of the patient, and confine by a horizontal circular turn, 2. At the 3d turn begin to drop the course of the bandage still more, so that on its completion it shall have been dropped one-half or three-quarters of its width. The 4th turn is to be made in a similar manner, cov- Circular of the Forehead and Eyes. ering the eyes and as much of the face as seems necessary; then, after an upward spiral course, 5, confine the bandage by a pin or thread, at or near its start- ing point. Uses.—This bandage, though necessarily so simple, fulfills many important indications. In wounds of the forehead, or upper part of the face, and operations thereon, in injuries and operations on the eyes and nose, and nasal passages, it serves [32J BANDAGES OF THE HEAD. 33 to convey proper soothing applications to the parts, as well as to restrain excessive muscular action, and so facilitates union between the edges of the wound. THE FILLET, OR HEAD-BAND. Description.—A piece of flannel, or cotton, thirty inches long by twelve inches wide. At a half an inch from the in- ferior border, midway from the two ends of the bandage, cut out a triangular piece (the base downwards) so as to leave an opening sufficiently large to admit the nose. Application.—Standing behind your patient, place the cen- tre of the bandage over the face, covering it from the mouth up; the nose being permitted FIG. 14 to pass through the triangular opening. Carry each end hori- zontally backwards about the head, and confine with pins or stitches. Uses.—This bandage admira- bly takes the place of the preced- ing in retaining dressings to the parts about the upper portion of the face. It can be used (though it is less elegant) in the place of the Monocle or Binocle, soon to be described. The Fillet, or HeaU-band. A ' Sling ' and a " Triangle " of the face have been devised, but they are really not so convenient as the Fillet. The former is a four-tailed bandage (made similarly as the Sling Compress, Fig. 4, page 22). The body of the bandage is placed over the face, and the extremities are carried backwards and fastened, the two superior at the nape of the neck; the two inferior above the occiput; or. they may be crossed at these points and brought forward, and finally confined in front. The Facial Triangle is applied in a similar manner. It should be, the base of the triangle, one yard in length; the height, that is from the base to the apex, should be eighteen inches, 34 MANUAL OF BANDAGING. CROSS OF THE EYE. {Monocle.) Description.—This bandage should be six yards in length and have a width of from one and a half to two inches. Application.—Taking the right eye, for example, standing behind your patient, place the initial end of the roller, 1, above FlG- 15-__________ the right eye, previously protected by a compress or some cotton- wool. Confine this by one hori- zontal circular turn, 2, about the head, and continue till you come to the occiput, for the next turn; here you make a pass down- wards, coming along under the right ear, then up over the in- ferior angle of the inferior maxilla of the right side, and across the inner angle of the orbit, finishing the third course of the bandage. Cross of the Eye. Continuing from this point (the forehead), the bandage is to be carried up over the left parietal protuberance, then down to a level with the circular turns 1 and 2, and finally finished as a circular of the head, thus making the fourth course. Course 5 is to be executed the same as course 3, remembering to overlap in its course, to the distance of one-half or three-quarters of its width, the preced- ing turn. Course 6 is executed the same as course 4, remem- bering the overlapping. Finally, when you come near the terminal end of your bandage, confine by one or two circular courses about the forehead and occiput, following course 2. Uses.—This is a very pretty and firm monocular bandage, when evenly applied; yet it is one that needs some watching lest some of the courses overslip each other, especially if put on a patient that is not very quiet. A light compress of cot- ton-wool should fill up the orbital cavity, this will not only BANDAGES OF THE HEAD. 35 keep the lids securely closed, but it will steady the eye-ball in its socket, as well as produce slight compression. In the case of the left eye, the proceeding is the same, reversing only the direction of the courses. For The Triangle of the Eye, see " Uses " under the bandage Fronto-oculo-occipital Triangle, page 36. CROSS OF THE EYES. {Binocle.) Description.—This bandage should be eight yards in length, and have a width from one and a half to two inches. Application.—Standing behind your patient, place the ini- tial end of the bandage, 1, over his Fig. 16. right eyebrow, and confine there by a horizontal circular turn about the head, 2. On the third turn, when coming to the occiput, pass the ban- dage down, so as to come around under the right ear, up over the in- ferior angle of the lower maxilla, and up over the inner angle of the orbit of the right side, thus finish- ing the third course of the bandage. From this point carry the bandage up over the left parietal eminence, Cross of the Eyes. then down to the occiput, and finally horizontally about the head, thus finishing course 4. Continue the course of the ban- dage horizontally about the head until you come to the occi- pital region, when you mount up over the right parietal eminence, and pass downwards over the inner canthus of the left eye, thus finishing the fifth course of the bandage. Con- tinue the bandage down across the left cheek and maxilla, and back under the left ear to the occiput, where you mount up to the level of courses 1 and 2, when you finish course 6 as a hori- zontal turn about the head. Turns 7, 8 and 9 are done the same as Nos. 3, 4 and 5, respectively; remembering always to draw in the bandage by 36 MANUAL OF BANDAGING. overlapping its underlying fellow by one-fourth, or one-third its width. On the completion of its application to the eyes, confine by a single horizontal turn about the forehead and occiput, fastening with a pin. Uses.—This bandage fulfils the same indications for both eyes that the preceding does for the one eye. The " double- headed " roller, for the same purpose, I have omitted, as it is not so firm a bandage, and is more complicated. The ears and parietal protuberances are the main points of support to these ocular bandages; hence, pay particular attention to the " laying of the bandage " about these pafts. FRONTO-OCULO-OCCIPITAL TRIANGLE. {Head-band of Mayor's System.) Description.—Take a piece of cotton cloth large enough so that, when folded to a triangle, the base of the triangle will measure one yard, while its height (from apex to centre of base) will be from fifteen to twenty inches. Application.—Standing behind the patient, place the base Fig. 17. °f the triangle over the eyes, having the apex over the head, pointing to the occiput. Carry both ends of the base horizontally around to the occi- put, covering over the apex of the bandage, and cross there, bring them forwards and confine at the forehead, A, a, either by pinning or tying. Lastly, carry the apex from the occi- put up over the horizontal courses of the two extremities to the region of the forehead, and confine with a pin, as at b. Uses.—This is a very simple bandage, as indeed all of Mayor's are, and will nicely take the place of the preceding Cross of the Eyes, or Binocle. It can be easily tilted to one side, covering in only one eye, so as to fulfil the condition of the monocular cross, plated on page 34. It is not so firm, or Fronto-Oculo-Occipital Triangle. BANDAGES OF THE HEAD. 37 evenly compressing a bandage, as the two preceding, and hence would not be so applicable after an operation for cataract, or an iridectomy. Of course, cotton-wool, or some light dressing, will need to be applied to the ocular fossae before the applica- tion of this triangle, just as in the Crosses of the Eyes. FRONTO-OCCIPITAL TRIANGLE. (Triangular Bonnet of the Head.) Description.—This bandage should measure one yard, or more, from end to end, across the base, and should have a height of fifteen or twenty inches. Application.—Standing behind the patient, place the base _ of the triangle, 1, at the forehead, over the eyes, having the apex at the occiput. Carry the two ex- tremities horizontally backwards to the occiput, covering in the apex, cross them there, and then bring them forwards and confine at the forehead, 2. Finally, bring the apex forwards, and confine as at b. Modifications,—I. By reversing Fronto-occipital Triangle. the application of this bandage, putting the base at the occiput and the apex at the forehead, you get the Occipitofrontal Tri- angle of Mayor. II. By placing the base at one of the sides of the head, the apex covering the other, you get Mayor's Biparietal Triangle. Uses.—The uses of these triangles are very numerous, as they are applicable for maintaining any dressing to almost any part of the head. In so doing they take the place, in great measure, of the Recurrent of the Head, and the Six-Tailed Bandage of the Head, to be described further on. SIMPLE CROSS OF THE CHIN. (Roller Bandage of the Chin.) Description.—This bandage should be about nine yards in length, and have a width of one and one-half inches. 38 MANUAL OF BANDAGING. your patient's back, place the initial end of the bandage, 1. over the left eyebrow, and con- fine by one single, horizontal, circular turn, 2, bringing the bandage down under the right ear, continuing it under the lower maxilla and up over the left maxillary ramus, and ear, finishing turn 3. Make, for turns 4 and 5, two vertical circular passes in the course of turn 3, gradually working towards the symphysis of the lower jaw, by overlapping each preceding turn one-half or one-fourth the width of the bandage. After turn 5 has been brought to the right inferior angle of the lower jaw, make a single horizontal circle of the neck, 6. At the back part of the neck mount up the occiput, so as to make the fronto-occipital horizontal turn 7. Then continue to the occiput, down below the right ear, across the symphysis of the chin, making turn 8. Circle the chin again, horizontally (course 9), then mount to the top of the head, passing under the lower jaw, forming turn 10, which is still anterior to turn 5. Turn 11 is made in the course of turn 10, overlapping it in its course. Bring the bandage down under the lower jaw again, thence circle the neck horizontally, forming turn 12. Finally, mount to the forehead, from the occipital region, and confine your bandage by a horizontal circular course, as 13. Uses.—In cases of fractures or dislocation of the lower jaw. It is also of use in confining any topical application to the chin, to the parotid regions, and to the ears. Care should be had that too much constriction is not put upon the neck in making turns 6 and 12, thereby hindering respiration and circulation. If a flannel roller is used no allowance need be made for the swelling of the parts, as the bandage will generally give enough, if it is only "comfortably" (to the patient) applied at first. Application.—Standing at Fig 19 Simple Cross of the Chin. BANDAGES OF THE HEAD. 39 FOUR-TAILED BANDAGE OF THE CHIN. {Sling of the Chin.) Description.—This bandage should be one and one-fourth yards in length, and have a width of pIG oo about five inches. It should be torn, at the middle of each end, towards the centre (as you see in Fig. 4, page 22), to within two and one-half inches of this point. Application.—Standing at the back of your patient, place the centre of the plane of the bandage, 1. at the chin; then carry the two superior ends of your bandage back- wards, below the ears, to the nape of the neck; crossing them here, bring slingo£ theC,lin- them upwards, and forwards over the parietal protuberances, and confine at the forehead, 2. Take, now, the two inferior ends of the bandage, carry them backwards and obliquely upwards across the temporo-maxillary articulations, and con- fine at the superior posterior angles of the parietal bones, 3. Uses.—This is quite a firm and solid bandage, and very easy of application. It does not, however, give that full sup- port to the parts that the preceding does, yet it is very applicable when the mobility of the parts is not over-increased by a very oblique or double fracture, or by extensive luxations of the inferior maxilla. For the maintaining of dressings to the chin, parotid region, and the ear, it is, from its simplicity, much to be preferred to the Simple Cross of the Chin. OCCIPITOMENTAL TRIANGLE. {Mayor's Triangle of the Chin.) Description.—Have your triangle with a base full one and one-half yards in length, and with a height of twenty inches, or more. 40 MANUAL OF BANDAGING. Application.—Standing behind your patient, place the base Fig. 21. of the triangle, a, the apex looking backwards, at the top of the head; seize the two ends of the triangle and bring one down below, and the other over and in front of the chin, cross- ing them this way, b, b, and then carry them obliquely back- wards and upwards, across the temporal and mastoid regions, to confine them at the summit of the occiput. Confine the Occipitomental Triangle. apex as at D- Uses.—This bandage was designed by Mayor to take the place of the two preceding bandages. This it does, in a meas- ure, in its ready applicability for the confinement of dressings about the regions it covers. It is easily extemporized, and hence is a "popular" way for maintaining topical applications to these parts. All of the more modern appliances for the treatment of fractures of the inferior maxilla are but modifications of the three bandages just given. A paste-board, or felt splint, with these bandages, will probably fulfil any of the indications that the more elaborate appliances are designed to, and are full as comfortable to your patient. CROSS OF THE HEAD. {Temple Bandage.) Description.—This bandage should be two inches in width by six or seven yards in length. Application.—Standing behind your patient, place the initial end of the bandage, 1, over the right eye, and confine it by a circular turn, 2, about the head. Continue on for a third course until you come to the right ear; here confine the BANDAGES OF THE HEAD. 41 bandage, either by stitches, or a pin, inserted perpendicularly with the roller-head, to the pos- _ . . . FlG- S2 terior angle of the inferior maxilla, covering over the right ear; then, passing under the lower jaw3 con- tinue the bandage up over the left ear to the top of the head; then descend to the horizontal courses of the bandage, thus com pleting course 4. Turns 5, 6, V and 8 are to follow in the course of turn 4, viz., perpendicularly around the head^ remembering to bring the bandage gradually for- wards, by overlapping each pre- ceding turn the quarter, or half, the width of the bandage. Turn 8 being brought to the level of the horizontal turn 2, upon the right side, it is to be fastened with stitches, or a pin, perpen- dicularly to the course of turns 6, 7 and 8, the remaining ban dage being exhausted by horizontal turns about the head and occiput, in the course of turns 1 and 2. In this application of the Cross of the Head, it has been sup- posed that it was the right ear. temple, or parotid region that was diseased or injured. In case of the left, you have but to reverse the application of the bandage; that is, make your turns from left to right, across the forehead, putting the initial end over the left eye. Uses.—For the protection or application of dressings to the ears, temples, parotid or hyoid regions. Is readily applied and makes a firm dressing. Cross of the Head. KNOTTED BANDAGE OF THE HEAD. Description.—This bandage should be one and a half inches in width, eight or ten yards in length, and rolled into two heads. 42 MANUAL OF BANDAGING. Application.—Place the plane of the bandage over the in- jured temple (the left, for example), and then carry the two Fig. 23. heads horizontally about the head to the right parietal region, where you cross one over the other; con- tinue them till you come to the starting point, thus finishing course 2. Crossing them here at right angles (that is, upon the diseased temple), carry one head of the bandage perpendicularly over the head, while you carry the other perpendicularly downwards under Knotted Bandage of the Head. the chin, 3, 3, continuing the course of each around the head and chin, until they meet at the dis- eased temple again, thus finishing the third course. Cross; them at right angles again at this point, continue horizon- tally about the head, as in course 1, until you come to the dis- eased temple again, thus finishing turn 4. Turn 5 is formed the same as was turn 3, and turn 6 as turn 4, etc., etc.; at last confine the ends of the bandage in the ordinary way. Uses.—This bandage is intended to exercise pressure upon the temporal artery, as in case of wounds, accidental or other- wise. It needs to be applied with care, and to be watched, as it is possible to make the compression too severe for a long- continued application of the bandage. It should always be aided by a Graduated Pyramidal Compress (see page 21). THE T OF THE HEAD AND EAR. {T of the Temple.) Description.—Take first a bandage from two to four inches wide (according to the extent of the injury to the side of the head) and one yard in length; at right angles to this bandage, at a distance of ten or twelve inches from one end, there should be stitched another bandage, two inches wide and two and a half yards in length, leaving one of its ends projecting some BANDAGES OF THE HEAD. 43 sixteen or eighteen inches beyond the first or widest por- tion. Application.—Place the point of juncture of the two ban- dages, a, over the right Fig. 24. temporal region, if this be the one involved, in such :i manner that the widest por- tion of the bandage, b, shall be perpendicular, as regards the head; then carry the long end of this wide por- tion of the bandage, u, down under the chin, and up on the other side to the top of the head, there tying or pinning it to the short , , . The T of the Head and Ear. end, brought perpendicular- ly upwards from the diseased temporal region. The longer and narrower portion of the bandage, a, is now to be carried hori- zontally about the head, the long end confining the short one by successive horizontal courses, till it is exhausted, when con- fine in the usual manner. Uses.—For confining dressings to the temporal, parotid and hyoid regions. PERFORATED T OF THE HEAD AND EAR. Description.—The first piece should be three yards long by two inches wide, and to this, perpendicular to its plane, there should be stitched, at eighteen inches from one of its ends, a bandage having the same length and width, save at the extrem- ity attached to the first piece; here it should be semi-oval, with a width two or three times that of the plane of the bandage; this oval part should be perforated by a longitudinal slit of sufficient size to "take in" the ear. Application.—Pass the ear of the diseased side (suppose it to be the right) through the second portion of the bandage, b, brino-ing the bandage closely and snugly up to the head. ■44 MANUAL OF BANDAGING. Fig. 25 Carry the shorter end of the horizontal portion of the ban- dage smoothly around the occiput and forehead, and confine by a single hori- zontal circular turn, 2. Carry, now, the perpen- dicular portion of the ban- dage, b, down under the chin, up over the opposite ear to the top of the head, and down to the starting point, thus finishing the first turn of the perpen- dicular portion of the ban- dage. Exhaust the re- maining portion of the bandage, b', by similar perpendicular turns about the head, and, at last confine the end, by a pin, to the horizontal turn 2. This done, exhaust the remaining portion of the roller, a, by horizontal turns about the head, confining as usual. Uses.—This bandage is found very useful in maintaining blisters to the mastoid process, or dressings thereto, as is fre- quently needed .in diseases of the ears. It is equally useful in confining dressings upon the ears, or the temporal, parotid, and tonsilar regions. Perforated T of the Head and Ear. OCCIPITO-AURICULAR TRIANGLE. (Mayor's Cross of the Head.) Description.—This should be a triangle having a base of one yard in length, and a height of some eighteen inches. Application.—This is essentially the same as that of the Occipito-mental Triangle (page 39). The only difference being that this one is crossed beloio, instead of upon, the chin. Uses.—Essentially the same as many of those for which The Knotted Bandage of the Head (page 41), The X °f the Head and Ear (page 42), and The Perforated "J" of the Head and Ear (page 43) are employed. BANDAGE OF THE HEAD. 45 Fig. 26. Recurrent Bandage of the Head. RECURRENT BANDAGE OF THE HEAD. (Roller Cap of the Head.) Description.—This should be one and one-half or two inches in width, and about nine yards in length. It should be rolled into two heads, one being a little larger than the other. Application.—Standing at the back of your patient, place the plane of the bandage above the eyebrows, carry- ing each roller head back- wards above the ears to the occiput; crossing them there at right angles, carry the inferior portion up over the top of the head, in line of the sagittal suture, 2, to the forehead; this is called the " recurrent" portion. Now, carry horizontally forwards the other roller-head, cross- ing over the recurrent portion (thus binding it down) at the left frontal region, thus finishing the horizontal turn 2'. Carry, now, the recurrent roller-head up over the horizontal turn 2' and the right parietal eminence down to the occiput, thus finishing the turn 3. Conduct the other roller-head again hori- zontally about the head, binding down the course 3 at the occiput, and finish it as turn 3' at the forehead. Courses 4, 6, 8 and 10 are made similar to course 2, whilst courses 5, 7 and 9 are formed similarly as course 3. The horizontal courses 4', 5', '6 and 7' are formed similarly as their preceding courses, 2' and 3', each binding down some one course of the recurrent portions of the bandage,—the turns 4, 5, 6, 7, 8, 9 and 10, which run from the forehead to the occiput. Uses.—This is not a very useful bandage, though it looks very nicely when properly applied. The objection to it is, that to give it the proper degree of firmness and security, one has to draw the confining turns of the bandage quite tightly; and this, from the repetition of these courses so directly above 46 MANUAL OF BANDAGING. each other, gives to the patient an uncomfortable feeling of tightness and constriction about the head. Besides this, if the wound is very large, it will press upon the bruised portions, and so cause excessive pain, and venous obstruction. In scalp wounds of the top of the head it might be used to good advan- tage. SIX-TAILED BANDAGE OF THE HEAD. (Sling of the Head, Galen's Bandage.) Description. — This bandage should be forty inches in length, by fifteen in width. Double it, lengthwise, at the middle; then, at a point (upon each side) three inches from the lateral border 1, cut directly toward the folded centre till you come to within three or four inches of it, 2. Then cut obliquely toward the same point, repre- sented by the line 3-2 in the cut, thus re- moving the triangular pieces 1-2-3 and 3-2-1. The portion 3-3 should be three inches in width. Application.—Place the plane of the Diagram. bandage upon the top of the head, the ends being at the sides. Bring the central ends a, a', directly down under the chin, and there confine by tying. Carry, then, the two front ends, b, b', horizontally backwards, and confine at the occiput. This done, bring the two pos- terior ends, c, 'c, hori- zontally forwards, and confine at the forehead. Uses.—This bandage is applicable for dressing any injury of the top or sides of the head. As it is simple, easily applied, and readily maintains its Fig. 28. Six-tailed Bandage of the Head. BANDAGES OF THE HEAD. 47 position, it may be preferred to the preceding and following. The suggestion that Galen makes (for it is known as his band- age) is a good one. It is to split the two middle ends, so as to allow the passage of the ears in cases where the condition of the patient will warrant such exposure. your patient, place Fig. 29. the TRIANGLE OF THE HEAD. (Handkerchief Bandage.) Description.—This bandage should be a piece of linen, or a handkerchief, twenty-four to thirty inches square. Fold it to a triangle. Application.—Standing behind bandage over the top of the head, the triangular portion hang- ing down over the face. Carry the two ends a, a', forwards to the forehead, there crossing them so as to carry them back, 2, 2, to the occiput, to be confined by tying or pinning. Then seize the triangular portion that hangs in front of the face, and carry it directly upwards and fold it un- der the horizontal turns of 2, 2', as at c. Uses.—As it is easily applied, and the material always at hand, it makes an excellent temporary bandage in cases of wounds or injuries of the upper portion of the head. It is not, however, quite so firm a dressing as the bandage just described. Triangle of the Head. DOUBLE T OF THE NOSE. Description.—A strip of flannel two and one-half yards long by one inch wide. At the central portion of this, at a distance of one inch from each other, there are to be stitched, at right angles with the first piece, two other strips, each thirty inches in length by three-quarters of an inch in width. 48 MANUAL OF BANDAGING. Application.—Standing behind your patient, place the plane of the main bandage (rolled into two heads) beneath the nose, a, and so that the other two portions, b', b, may pass up, one Fig. 30. upon each side, along the nose. Carry the heads of the main bandage, a, horizontally back- wards to the occiput, and cross one head above the other , then take the two perpendicular por- tions of the bandage, b', b, up over the top of the head, having them cross each other at the root of the nose, so that the right will pass over the left parietal region, and continue Double T of the Nose. theh. courses down to the neck> passing one of them beneath the crossed courses of the main part, a; then carry the two roller-heads, a, a', obliquely up- wards across the forehead, and confine with pins, etc., after exhausting both by horizontal turns about the forehead and occiput. This done, tie the ends of the portions b', b, about the first turn of the roller-heads of the portion A, at the nape of the neck. Uses.—To maintain dressings to the parts about the nose, as in cases of injury, or after a rhinoplastic operation; or, to hold coapted the nasal bones, when fractured. T OF THE MOUTH. Description.—This bandage should be, the main piece, two yards long and two inches wide. At twenty-four inches from the initial end of this piece there should be stitched (at rio-ht angles) to the superior border, a second strip, two feet in length by two inches in width. Cut out a triangular piece,, large enough for the passage of the nose, from this second bandage at the place where it is joined to the main roller. Also, from the main roller, at a point below the triano-ular opening for the nose, cut out a sufficiently large, oval section to accommodate the mouth and lips. BANDAGES OF THE HEAD. 49 Application.—Standing behind your patient, place the plane of the bandage across the face, so that the oval aperture will correspond to the mouth, and the Fig. 31. triangular to the nose; carry the two ends of the main bandage, a, a', backwards under the ears to the nape of the neck, and cross them, one above the other, there. Then conduct the perpendicular portion of the bandage, b, up between the eyes, over the summit of the head, down to the crossed ends of the part a, a', and either confine there by pins or stitches; or, after pass- T of the Mouth. ing under and then over the crossed courses of the main band- age, remount the head and confine at or near the forehead. This done, carry the ends of the main bandage forwards over the ears and exhaust them by horizontal turns about the fore- head and occiput, as at a 2, the shorter extremity being first applied. Uses.—For confining dressings about the mouth, jaws, cheeks, or for maintaining the parts in apposition after plastic operations, or other surgical procedures. This, and the preced- ing bandage, is especially applicable in cases of transverse wounds of the lip at the nasal alae, or fraenum. INVAGINATED ROLLER OF THE UPPER LIP. (Hare-lip Bandage.) Description.—I. A two-headed roller, three yards long by three-quarters of an inch wide. II. A long, narrow compress, say one and one-fourth yards in length by two inches in width. III. A graduated, pyramidal compress, two inches in length, one and one-half inches in width, and one inch in thickness. The folds of the compress should be stitched through and through, at each end, in order to prevent them slipping. Application.—Place the graduated compresses a, a', one upon each side, in the hollow of the cheeks, below the zygoma, mm* 50 MANUAL-OF BANDAGING. Invaginated Roller of the Upper Lip. and at about one inch distance from either angle of the mouth, Fig. :;2. pressing the cheeks and lips well forwards towards the median line. Delivering them to the care of an assistant, take the long compress, b, and place its middle over the sum- mit of the head, allowing the ends to hang down over the sides of the face, and to cover in the graduated compresses, the patient finally hold- ing the ends together under the chin. This done, place the plane of the double-headed roller, 1, upon the forehead, standing behind your patient, and carry the heads back- wards and downwards to the nape of the neck, here cross- ing them to carry them horizontally forwards to the supe- rior lip, 2, 2', passing one through a slit in the other. Then carry them horizontally backwards to the neck, crossing them again at that point, to carry them forwards to the lip again, passing one through the other as before, thus finishing turn 3, 3', consigning the heads to an assistant. Take, now, the two ends of the long compress that has been confined temporarily, by the patient, and fold each upwards over the circular turns of the roller, and confine with pins at the temple, or top of the head. This done, take the roller-heads, carry them horizontally backwards (over the folded compress) to the nape of the neck, recrossing them to mount up to the forehead, and exhaust there by horizontal circular turns. Uses.—Useful in all wounds of the lips for keeping the parts coapted; in operations for cure of "hare-lip" where the tissue seems to be scanty, and the lip-wounds are hard to bring together, it is especially applicable. Variety.—This bandage can be made equally available for wounds of the lower lip. It is then to be known as the Invagi- nated Poller of the Under Lip. The only difference in the application being that the pyramidal compresses, a, a', shall BANDAGES OF THE HEAD. 51 be dropped lower, and that the crosses of the bandage 2, 2', and 3, 3', shall take place upon the labium inferius. FRONTO-CERVICO-LABIAL TRIANGLE. (Mayor's Invaginated Triangle of the Upper Lip.) Description.—A square should be folded to a triangle hav- ing a base of forty inches, and a height of eighteen inches. Application.—Place the centre of the base of the triangle upon the forehead, a, carrying the Fig 33. extremities down and backwards to the nape of the neck, covering over the apex of the triangle, there cros- sing them; then bring them forward over the upper lip, putting one ex- tremity through the slit in the other, as 2, 2'. Carry the ends horizontally backwards to the nape of the neck, there confining them by tying, or otherwise. The apex of the triangle is to be carried directly up over the Fronto-Cervico-Labial Triangle. occiput and pinned at the summit of the head, as at 3. Com- presses, similar to those used in the preceding, can be employed to advantage in this bandage of Mayors; and they are especi- ally indicated if much tendency to gaping exists in the wound. Uses.—The same as those of the preceding. As it is more easily applied, and quite as serviceable, it might be recom- mended, in most cases, to take the place of the Roller Invagin- ated for the Upper Lip. Variety.—Instead of crossing the extremities of the triangle upon the upper lip, they can be made to cross upon the under one, and thus fulfil the indications of The Roller Invaginated of the Under Lip, ^escribed upon page 50. It is then known as The Invaginated Triangle of the Under Lip. POSTERIOR CROSS OF THE HEAD AND NECK. (Cross of the Occiput.) Description.—This bandage should be five yards in length, and one and one-half inches in width. 52 MANUAL OF BANDAGING. Application.—Standing at your patient's back, place the ini- FIG 34 tial end of the bandage near the occiput, as at 1, and confine it by a single horizontal turn, 2; afterwards carry it round to the forehead, in the course of turn 2, till you come to the left parietal protuberance, when you carry it diagonally down to the nape of the neck, making a horizontal circular turn about it for course 4. For course 5, carry the roller head obliquely up across the occiput, ovter the right ear, then obliquely down to the nape of the neck, from over Posterior Cross of the Head and tbe left ear> thu8 finishing Course 6. Neck. . Course 7 is the same as course 5. Course 8, the same as course 6, and so on; at last finish by horizontal turns, about the forehead and occiput, and confine with pins as usual. Uses.—In confining rubefacients and vesicants to the nape of the neck; also for retaining dressings, or emollient applica- tions, to burns and other injuries about the occipital region. FOUR-TAILED BANDAGE OF THE HEAD AND NECK. (Sling of the Occiput.) Description.—This should be forty-eight inches in length by five inches in width. Fold it lengthwise, at the centre, and cut back the ends, in the median line, to within three or four inches of the fold. Application.—Place the plane of the bandage at the nape of the neck; carry the superior ends of the bandage up over the head, and confine there by tying. Thenfcarry the inferior ends horizontally forwards around the neck, and tie; or else cross them, and return to the back of the neck with them, and there pin. Uses.—Similar to that of the Posterior Cross of the Head and Neck, described above. CHAPTER VII. BANDAGES OF THE NECK. CIRCULAR OF THE NECK. (Spiral of tlie Neck.) Description.—This bandage should be one yard in length, and one and a half inches in width. Application.—Place the initial end of the bandage at one side of the neck, quite low down, and exhaust it by circular turns, gradually working upwards to the jaw, so as to give a spiral form to the courses of the bandage. Confine in the usual way. Uses.—Is useful in maintaining dressings to the back, sides, or front of the neck. Caution should be observed that it does not constrict the parts, and so impede circulation. CERVICAL CRAVAT. Description.—A triangle folded to a cravat of sufficient length to encircle the neck twice. Application.—Place the middle of the cravat over or near the seat of injury, carry the ends horizontally backward, cross them and bring forwards again, and confine by tying. Uses.—Similar to the Circular of the Neck; as it is much simpler, this bandage of Mayor will probably be more often used than the preceding. POSTERIOR FIGURE OF 8 OF THE HEAD AND THE AXILLAE. Description.—This bandage should be nine yards long by one and three-quarter inches wide. 54 MANUAL OF BANDAGING. Application.—Standing at the back of your patient, place the initial end of the bandage at the occiput, 1, and confine by a horizontal turn, 2, about the head. Bend, now, the patient's head backwards, and carry the bandage up over the left parietal protuberance, then down across the neck to the right axilla, thus finishing turn 3. Then carry the roller- head under the arm, up over the front of the right shoulder, then to the left parietal protuberance, in line of course 3, thus finish- ing course 4. Continue the course of the bandage Posterior Figure of 8 of the Head and the about the forehead, mount the right parietal eminence, and descend diagonally down across the back of the neck, to the left axilla, thuc finishing course 5. Pass the bandage under this arm, up over the front of this shoulder, and re-mount to the right side of the head, in line of course 5, thus finishing turn 6. Make, then, a complete horizontal circuit of the head for course 7~ coming down over the left parietal eminence to the right axilla for turn 8. Make course 9 similar to course 4, course 10 to course 5, course 11 to course 6, slightly overlapping the preceding turn in each case, and finally exhaust by horizontal turns about the forehead and occiput, there confining as usual. Uses.—In cases of burns of the anterior surface of the neck and the upper part of the chest, where vicious contraction of the cicatrix is to be feared. Also in horizontal wounds of the back of the neck, thus aiding in securing the proper coaptation of the parts. This is quite a firm bandage, and most any de- gree of backward flexion of the head can be maintained. Note.—Turns 4, (5 and 9 have been exaggerated, at their BANDAGES OF THE NECK. 55 crossings upon the back of the neck, in order to show their courses more plainly. In other words, they are too angular, as represented in the cut. DOUBLE POSTERIOR T OF THE HEAD AND THORAX. Description.—Same as Double Anterior f of the Head and Thorax, page 56. Application.—The reverse of that bandage, the head being flexed backwards; the application is then essentially the same as seen in cut No. 36. Uses.—The same as those of the Posterior Figure of 8 of the Head and the Axillae, and may be preferred to it. FRONTO-DORSAL TRIANGLE. Description.—The same as the Occipito-Sternal Triangle described on page 57. Application.—The reverse of the Occipito-Sternal Triangle. Imagine your patient to be with his back to you, in Fig. 36, and the application will then be readily understood, as it is so similar. Uses.—Mayor designed this to take the place of the Pos- terior 8 of the Head and Axillae, and the Double Posterior X of the Head and Thorax, which it does admirably. ANTERIOR FIGURE OF 8 OF THE HEAD AND THE AXILLAE. Description.—This bandage should be nine yards in length by one and three quarter inches in width. Application.—This bandage is to be applied just the re- verse of that shown in Fig. 35; that is, stand in front of your patient, and place the initial end at the forehead, flexing the head forwards upon the chest. Uses.—In cases of burns of the back of the neck, or upper portion of the back, where vicious cicatricial contraction is to be feared. Also for transverse wounds of the front part of the neck. This bandage is not often employed, on account of the inconvenience experienced from the crossings of the bandage, which occur upon the patient's face. Either the following, or the Occipito-sternal Triangle, is to be preferred to it. 56 MANUAL OF BANDAGING. Fig. 36. DOUBLE ANTERIOR T OF THE HEAD AND THORAX Description.—I. A broad band, eight or ten inches wide, and sufficiently long to encircle the chest. II. Two shoulder strips to act as " suspenders " of this broad thoracic band. III. A bandage three yards long and one and three-quarter inches wide. To the superior border of this bandage, at a dis- tance of twenty inches from the initial end, is to be sewed (at right angles) a strip two feet long, by one and one quarter inches wide. To the inferior border (at nearly right angles) are to be sewed two strips, each eighteen inches long by one inch wide, at three inches distant, each way, from the lateral borders of the strip sewed to the superior border of the main bandage; thus having some eight inches intervening between the two inferior strips. Application. Encircle the thorax with the broad band, a, confiningby pins or stitches; and to it pin the " suspend- ers," b, b\ This done, place the initial end of the roller upon the forehead, c-i, and confine by a horizontal turn, 2 ; carry the single band, d, up over the top of the head, and down under the hori- zontal course of the main bandage, at the occiput, again remounting the head and confining with a pin or stitches. After this, exhaust the roller, c, by horizontal courses about the forehead and occiput. After doing this, flex the head upon the chest to that degree deemed requisite, Double Anterior T of the Head and Thorax. BANDAGES OF THE NECK. 57 and confine it there by pinning the strips e', e, to the thoracic band, a. Uses.—Same as those of the Anterior Figure of 8 of the Head and Axillae, and is to be preferred to it. OCCIPITO-STERNAL TRIANGLE. Description. — I. A triangle one yard long, and having a height of eighteen inches. II. A triangle of the same size folded to a cravat. Application.—Place the centre of the cravat at the ster- num, and conduct both ends backwards, under the axillae, and confine with a knot, at the back. Place, now, the centre of the base of the triangle at the fore- head, carry the two ex- tremities backwards, over the apex of the triangle, to the occiput, crossing them here to conduct them for- wards, and obliquely down- wards to the sternum, after having pinned them at the sides of the head. Flex the head sufficiently, and occipito-stemai Triangle. then tie them about the cravat. The apex of the triangle can be confined as in ordi- nary cases. Uses.—Mayor designed this bandage to take the place of the Anterior 8 of the Head and Axillae, and the Double Ante- rior T of tne Head and Chest, which it does admirably; and for readiness of application, and the abundant security it gives, it is to be preferred to them. 58 MANUAL OF BANDAGING. FIGURE OF 8 OF THE HEAD AND AXILLA. (Lateral Bandage of tlie Neck.) Description. — This bandage should be six yards long, by one and three-quarter inches wide. Application. — Standing behind your patient, place the ™ QO • initial end, 1, at the fore- r IG oo. head, and confine by a'sin- gle horizontal turn, 2. Hav- 'ing arrived at the occiput, on the third course, flex the 1 atient's head on the side injured, the right for in- stance, and carry the ban- dage down in front of the right shoulder to the axilla, i bus finishing turn 3. Con- tinue the course of the bandage beneath the righl nxilla, and up to the fore- head; here reverse and con- fine with a pin, thus finish- Figure of 8 of the Head and Axilla. ing turn 4. Turn 5 is to be in the course of turn 3, turn 6 of turn 4, and so on. At last exhaust the bandage by horizontal turns about the fore- head and occiput, or the right arm, as a', or a. Uses.—In cases of burns of the side of the neck where vicious cicatricial contraction is feared; or, of transverse wounds of the sides of the neck, when gaping would other- wise persist. PARIETO-AXILLARY TRIANGLE AND CRAVAT. (Lateral Triangle of the Neck.) Description.— I. A triangle having a base one yard in length, with a height of sixteen inches. II. A triangle of same size folded to a cravat. BANDAGES OF THE NECK 59 Application.—Pass the cravat, a, under the left axilla, sup- posing you wish to incline FIG 39 the head to the left, and tie in front of the shoulder. Place the base of the tri- angle, b, over the left parie- tal region, and carry the two extremities horizontal- ly around the head, cross them, flex the head towards the left shoulder, and bring them down and tie to the cravat. Confine the apex of the triangle with a pin, as usual. Uses.—This bandage of Mayor fully takes the place Parieto-Axillary Triangle and Cravat. of the preceding, and is far preferable to it, so far as ease of application and removal is concerned. It is equally efficacious in restraining the movements of the head. May be applied to either side of the head. CHAPTER VIII. BANDAGES OF THE UPPER EXTREMITY. SPIRAL OF ONE FINGER. Description.—This bandage should be one and one-half yards in length by three-quarters of an inch in width. Application.—Suppose it is the right fore-finger to which Fig 40 y°U w*sn to aPPty t^ie Dan(Iage. Pronate the hand; after unrolling four or five inches of the bandage, place it upon the back of the wrist, as 1, and confine it by a single circu- lar turn, 2. Continue the course of the bandage about the wrist till you come to the ulnar border, when you cross down the back of the hand (course 3), and continuing the course of the bandage onwards along the radial side of the forefinger, you en- circle this at the tip, as course 4. Courses 5, 6, 7, 8, 9, 10 and 11 en- circle the diseased member spirallv; Spiral of one Finger. . while course 12 runs obliquely up- wards, from the first finger-cleft, across the back of the hand to the radial side of the wrist, partially encircling it, when you tie both extremities, as at 13. Uses.—For maintaining the coaptation of severed' parts, when there is a longitudinal wound; also for confining dress- ings and splints to the part. This bandage is applied to any one of the fingers, or the thumb, of either hand. F601 BANDAGES OF THE UPPER EXTREMITY. 61 POSTERIOR FIGURE OF 8 OF THE THUMB AND WRIST. (Spica of the Thumb.) Description.—This bandage should be two yards in length by three-quarters of an inch in width. Application.—If it be the right you wish to bandage, place the hand midway between pronation prG 41 and supination. Unroll four or five inches of the bandage, and thus place it, 1, upon the back of the wrist, and confine by two circular turns, 2 and 3; continue in the same course till you come to the ulnar border of the hand, when you descend ob- liquely across the back of the hand to the radial side of the thumb, at the phalangeal articulation, thus fin- ishing course 4. Pass under the thumb, and then up over it, and diag- onally upwards to the radial side of the wrist, finishing course 5. Courses 6, 8, 10, 12 and 14, etc., respectively follow the course of turn 4; while those of 7, 9, 11, 13 and 15, those of course 5. At last exhaust the bandage by circular turns about the wrist, and confine by tying. Uses.—For confining dressings to the back of the thumb, or the first metacarpal space; also as dressing after the reduction of a dislocation of the first phalanx. It can be applied so that the spiral shall run downwards, instead of upwards, as we have given; but the descending spiral can rarely be put on so evenly and regularly. Posterior Figure of 8 of the Thumb and Wrist. POSTERIOR FIGURE OF 8 OF THE HAND AND WRIST. Description.—This bandage should be one and one-half yards in length by one and one-quarter inches in width. '62 MANUAL OF BANDAGING. Application.—Place the initial end, 1, on the back of the Fig. 42. wrist—the left, for example,—and confine by a circular turn, 2; con- tinue the course of the bandage about the wrist till you come to the radial border, when you descend ob- liquely across the back of the hand to the fifth metacarpophalangeal articulation, thus finishing turn 3. Turn 4 is a circular course about the metacarpophalangeal articulations; while course 5 ascends, obliquely, across the hand, from the radial bor- der of the fore-finger, to the ulnar border of the wrist. Turn 6 is a simple circle of the wrist. Course 7 is in.line of course 3, slightly over- lapping it; course 8, in line of course 4; course 9, of course 5. Exhaust the bandage, at last, by simple circles about the wrist, and confine in the ordinary way. Uses.—For confining dressings to the back of the hand or wrist, as cataplasmata, graduated compresses over ganglionic cysts, etc.; also as an after-dressing after a dislocation back- wards of the os magnum, or any of the dislocations backwards of the first row of phalanges. Posterior Figure of 8 of the Hand and Wrist. ANTERIOR FIGURE OF 8 OF THE HAND AND WRIST. Description.—This bandage should be one and one-half yards long by one and one-quarter inches wide. Application.—Just the reverse of that seen in figure 42; that is, imagine the palm of the hand presenting, and then apply as above described. Uses.—To confine dressings to the palm of the hand, and to the anterior surface of the wrist; also to confine compresses to the region of the palmar arches, in case the vessels are wounded, and ligation is called for. BANDAGES OF THE UPPER EXTREMITY. 63 POUR-TAILED BANDAGE OF THE HAND. (Sling of the Hand.) Description.—This bandage should be eighteen inches in length by three or four inches in width. Fold the ends together, and then tear, or cut them back to within two inches of the folded centre, thus making a bandage similar to the compress seen in figure 4, page 22. Application.—Place the plane of the bandage either upon the palm or the back of the hand, according to the seat of injury. Tie the inferior ends about the metacarpophalangeal articulations; the superior ends you carry obliquely upwards to the wrist, and confine them there by tying about it. Uses.—This bandage is intended to take the place of the Posterior and Anterior Figure of 8's of the Hand and Wrist, in injuries about the palm or the back of the hand. As it is more easily applied, it has, perhaps, become a more general favorite.* DOUBLE T OF THE BACK OF THE HAND AND WRIST. Description.—The main bandage, a, should be some twenty- eight inches in length by one inch in width. At a distance of three inches from the initial end, stitch, at right angles, another bandage, b, twenty inches long, by three-quarters of an inch wide; at a point two inches from this, stitch, at right angles to the plane of the main bandage, and parallel to b, another bandage, c, of the same dimensions as b. Diagram. Application.—Place the initial end of the bandage, a, upon the back of the wrist, so that the first perpendicular portion *Note.—The systems of Triangles and Cravats are so readily applied to the hand, and are in such common use by the laity, even, no descrip- tion of them is thought necessary. 64 MANUAL OF BANDAGING. of the bandage, b, will correspond to the first interosseous space, and the portion c, with the fourth interosseous space. Confine the initial end by a single circular turn, 2, about the wrist. Carry the portion b down the first interosseous space, around over the palmer surface of the first joint of the index Fig. 44. finger, and then back, over the second interosseous space, to the wrist; this done, make another cir- cular turn about the wrist with the main bandage, as turn 3, running over the recurrent portion of b at the wrist. Continue these circular turns of a until the bandage is ex- hausted, when confine with a-pin. Conduct, now, the other perjien- dicular portion, c, down the fourth interosseous space, across the palmer surface of the metacarpo-phalangeal articulation of the ring-finger, back, Double t of the Back of the over the third interosseous space, to Hand and Wrist. the wrist, here tying with the end or the first portion, b, as at d, after the requisite amount of extension of the palmar tissues, or fingers, has been obtained. Uses.—In cases of burns of the palm of the hand, or ex- tensive suppurations, where vicious cicatricial contractions are to be feared. In cases of injuries of the finger-clefts, from burns or otherwise; here using compresses, soaked in carbolized oil, to prevent the union of the sides of the fingers from "an- gular" granulation. Also for confining dressings to the back of the hand. Variety.—Single T of the Back of the Hand and Wrist.— In this case but one perpendicular portion of the bandage is used, as b, or c; it being applied between any finger-clefts de- sired, and in a manner similar to the above. The uses are similar to the Double X just described, only are more limited. BANDAGES OF THE UPPER EXTREMITY. 65 DOUBLE ANTERIOR T OF THE HAND AND WRIST. Description.—The same as the Double X °f tne Back of the Hand and Wrist (page 68). Application.—The reverse of the Double X of the Back of the Hand and Wrist; that is, it is to be applied to the front of the hand. Uses.—Similar to the above in cases of finger-cleft injuries, or after web-finger operations. Also in cases of burns across the back of the metacarpophalangeal articulations, or trans- verse wounds across the front of the same joints, the point in the use of the dressing being to forcibly flex the first row of phalanges as much as possible. Variety.—Single Anterior T of the Hand and Wrist.— Only one perpendicular, or finger-cleft, portion of the bandage is to be used. It can be applied to any of the finger-clefts de- sired. The uses are similar to the Double Anterior X °f the Hand and Wrist, only they are much more limited. PERFORATED X OF THE HAND AND WRIST. Description. — A bandage, a, a', eighteen inches in length by one inch in width. At the middle of this, at right angles to it, stitch a piece of linen, or flannel, b, twelve inches in length by four inches in width, having five per- forations; the first, corresponding, from its size and position, with the thumb, as c The other perforations are made at such a distance from each other, and of such size, as will readily admit the fin- gers. ' Diagram- Application.—Suppose it to be the right hand. Carry the fingers and thumb through their respective perforations in the 66 MANUAL OF BANDAGING. Fig. 46. Perforated T of the Hand and Wrist. portion b, and place the portion a at the back of the wrist. Carry forwards the lower portion of b (see figure 45), up across the palm of the hand, folding it about the wrist, as d, d'. Conduct, now, the two ex- tremities of the main bandage (a, a', figure 45) circularly about the wrist, binding down the recurrent portion of b (d, d') ; and when exhausted, tie the ends together, as at c. Uses. — Designed to take the place of the Double or Single X Bandage of the Hand and Wrist; also for confining dressings to the palm of the hand, as well as to the dorsal portion. CARPO-DIGITO-PALMAR TRIANGLE. Description.—This should be a triangle having a base twenty-four inches in length and a height of twelve inches. Application.—Place the base of the triangle upon the palmar surface of the wrist; conduct both extremities circu- Fig. 47. larly around the wrist, tying at the back. Fold the sides of the triangle over the dorsum of the hand, and carry the apex of the triangle up over the back of the fingers (extending them as circumstances demand) to the wrist, as at b, there con- fining. Uses.—For maintaining dressings to the palm of the hand, and also for ex- tending the fingers upon the forearm, in cases of burns of the palm, where vicious cicatrization is to be feared; also in transverse wounds of the back of the hand. In these latter cases it takes the place of the Double X °f the Back of the Hand and Wrist. Carpo-Digito- Palmar Triangle. BANDAGES OF THE UPPER EXTREMITY. 67 CARPO-DIGITO-DORSAL TRIANGLE. Description.—Same as Carpo-Digito-Palmar Triangle. Application.—The reverse of that seen in figure 47, in that you place the base of the triangle at the back of the wrist, con- fining as in the preceding case. Afterwards fold the apex up over the palm of the hand, thus flexing the fingers upon the forearm, and confine at the wrist. Uses.—For maintaining dressings upon the hand, and for maintaining the fingers in a state of flexion, when vicious cica- trization is to be feared upon the back of the hand; also, in cases of transverse wounds of the palm of the hand. It is then designed to take the place of the Double Anterior X of the Hand and Wrist. SPIRAL OF ALL THE FINGERS. (Gauntlet.) Description.—This should be a bandage ten yards in length by three-quarters of an inch in width. Application. — Suppose Fig. 48. it be the right hand to which it is to be applied. After letting drop four or five inches (enough to tie with) of the initial end, place the bandage upon the back of the wrist, 1, and confine by the circular turns, 2 and 3; afterwards you come obliquely down across the back of the hand, from the radial side, to the little finger, finish- ing course 4. Continue the bandage outwards to the tip of this finger, mak- ing a circular turn, 5, and Spiral of Allthe Fingers 68 MANUAL OF BANDAGING. Fig. 49. the spiral turns 6, 7, 8, 9, 10, 11, 12, 13 and 14 about the same. member; then conduct the bandage upwards and outwards from the fourth finger-cleft to the palmar surface of the wrist, thus finishing course 15. Course 16 is essentially that of course 4, with this difference: it goes to the ring finger; this finger is spirally bandaged, and the recurrent course, 27, of the band- age is similar to that of course 15. Each of the remaining fingers are similarly wound, and at last both ends of the ban- dage are tied at the back of the wrist, or forearm, 62. Uses.—In cases of fracture, or dislocation of the phalanges, and burns or other wounds of the fingers and hand, where vi- cious cicatricial contraction is to be feared, or after an opera- tion for web-finger. SPIRAL OF THE FINGERS AND THE HAND. Description. — This bandage should be three yards, or more, in length, and one and one-quarter inches in width. Application.—Place the initial end of the bandage, 1, at or near the extremities of the fingers, and confine by the spiral turn 2; make six other spiro-circular turns about the fingers, and on the 9th, 10th, 11th, 12th, etc., courses, make the reverse to each turn, so as to accommodate the obliquity of the thumb, and thus prevent the ban- dage slipping off. At last exhaust by simple circular turns about the wrist, or lower part of the forearm, and confine with the pin, as usual. Uses.—In cases of fracture, or dislocation of the phalanges; and also for confining dressings to any part of the hand and wrist. If the fingers should each, separately, de- mand compression, then the Spiral of All the Fingers (The Gauntlet) should be employed. Spiral of the Fingers and the Hand. BANDAGES OF THE UPPER EXTREMITY. 69 THE SHEATH OF THE FINGERS. Description.—Instead of the more elaborate ones recom- mended by some authors, you can use the fingers from a large glove; or, if the whole hand is to be enveloped, a mitten. Uses.—In the simpler injuries about the hand where the more complex bandages are hardly called for. FIGURE OF 8 EXTENSOR OF THE HAND UPON THE FOREARM. Description.—This bandage should be six yards in length, by one and a half inches in width, and rolled into two equal heads. Application.—Place the plane of the roller upon the back of the hand, 1, conduct both heads to the palm, cross them, one above the other, a,nd remount to the back, crossing them there, 2, 2, and conduct them to the palm again. Re - crossing them, carry the heads up- wards across the arm, 3, 3, to a point above the ole- cranon process, the hand being sufficiently extended; make a circle of the arm at this point, 4, 4, crossing the heads before and behind, and at last descend upon the arm again, 5, 5, to make another circuit about the hand, thence to remount to the elbow again. Finally ex- haust both heads by circular turns above the elbow, confining as usual. Ftg. 50. Figure of 8 Extensor of the Hand upon the Forearm. 70 MANUAL OF BANDAGING. Uses.—In cases of burns of the palmar surface of the hand, wrist or forearm, where vicious cicatricial contraction is to be feared, and in all other cases, where extension of the hand upon the forearm is desired, as in transverse wounds of the back of the wrist. FIGURE OF 8 FLEXOR OF THE HAND UPON THE FOREARM. Description.—This bandage should be six yards in length, by one and a half inches in width, and rolled into two equal heads. Application.—Similar to the preceding ; the plane of the bandage being placed at the palm of the hand, the member being flexed upon the forearm. Courses 1 and 2 are to be made as in the Extensor of the Figure of 8 of the Hand upon the Forearm, and the heads carried above the elbow and the remaining courses made in a similar manner to those of the preceding bandage. Uses.—In maintaining forward flexion of the hand upon the forearm, as in case of burns of the back of the hand, wrist and forearm, where vicious cicatricial contraction is to be feared. Also in cases of transverse wounds of the forepart of the wrist, where a tendency to gaping occurs. CARPO-OLECRANON CRAVAT. Description.—I. Two cravats, each eighteen inches in length. IL A third cravat, thirty-six inches in length. Application.—Tie one of the short cravats about the hand, as at a ; and then tie the other about the arm, above the olecranon process, as at b. Extend, now, the hand upon the forearm, and confine it by tying the long cravat, c, between, and to, them. BANDAGES OF THE UPPER EXTREMITY. 71 Uses.—The same as the Figure of 8 Extensor. As these cravats are easier applied, and full as safe as the roller band- age, they are to be pre- ferred to it. Variety.—If need be, a Flexor variety of this cravat may be employed. In this case the hand is flexed upon the anterior surface of the forearm, by running the long cra- vat, c, down the anterior surface of the member. This bandage would then take the place of the Fig- ure of 18 Flexor of the Hand upon the Forearm just described. SIMPLE SPIRAL OF THE FOREARM. Description.—This bandage should be two yards in length by one and a half inches in width. Application.—Place the initial end at the wrist and con- fine by a circular turn above it; exhaust the bandage by en- circling the arm with spiraliform turns, as you see in the upper courses of the bandage depicted upon page 68. Uses.—To retain dressings upon the forearm. REVERSED SPIRAL OF THE SUPERIOR EXTREMITY. (Roller of the Superior Extremity.) Description.—This should be twelve yards in length by one and one-half inches in width. Fig. 51. Carpo-Olecranon Cravat. 72 MANUAL OF BANDAGING. Application.—See figure 11, page 28. This bandage is to be applied as here represented, the courses being continued upwards to the axilla, here confining in the usual way. Uses.—Most generally employed in cases of fractures, etc., to restrain muscular action, swelling, and to favor the rtturn of venous blood to the vena cava superior. When employed the surgeon should guard himself that he does not allow un- equal pressure at any of the courses of the bandage. Should Fig. 52. he have one part of the member more tightly constricted than another, he will only in- crease the mischief already done by the accident by favoring the development of gangrene, from venous stagnation, at the more constricted portions. When evenly and smoothly applied this bandage is of great service to the surgeon; when inaptly applied, a source of great danger to his patient and chagrin to himself. (See note at foot of page 74). Variety.—When it is specially desired to secure the limb with a bandage that shall not slip, and where steady pressure may be continued for some little time, as in " green stick " fractures, then adhesive bandage, or what is better, the porous adhesive bandage of Grosvenor & Richards could be used, as shown in the cut, in place of the flannel or cotton roller. There would not need to be Reversed Porous Spiral quite as long a bandage used in these cases, of the Superior Ex- ^ . tremity. as the overlapping of the courses would be less in extent. The punched holes in the "porous" variety would allow free exit for all discharges, should it be applied over a wounded surface. ANTERIOR FIGURE OF 8 OF THE ELBOW. Description.—This bandage should be two and a half yards in length by one and a half inches in width. BANDAGES OF THE UPPER EXTREMITY. 73 Application.—Suppose it to be the right arm to be band- aged. Place the initial end of the -pTG r)o bandage, 1, above the bend of the elbow, and confine by a single circu- lar turn, 2. Continue in the same direction till you get to the out- side of the arm, when you descend diagonally across the front of the joint, to a point four or five inches below it, thus finishing turn 3. Turn 4 is a circular course about the upper portion of the forearm; turn 5, a spiral turn upwards to the inside of the arm above the bend of the elbow; Anterior Figure of 8 of the whilst turn 6 is in course of turn 3; Elbow. turn 7, of course 5, and so on; at last exhaust by circular turns about the arm, and confine as usual. A variation can be made, and to good advantage sometimes, by making course 6 to be a circular turn about the arm, as course 2; course 7 then being the same as course 6 in the figure, whilst course 8 is a circle of the forearm, as course 4 in the wood-cut; course 9 would then take the place of course 7 in the cut. Uses.— Generally to fix a compress over the median- cephalic vein after venesection. Can be employed in cases of wounds in that region, or for maintaining dressings thereto. Variety.—By making similar courses of the bandage upon the posterior surface of the arm and forearm, you get the Pos- terior Figure of 8 of theElbow. The Uses of this variety are essentially to confine dressings about the back of the joint. A Triangle of the Elbow and also a Four-tailed Bandage (Anterior and Posterior) have been devised to take the place of the roller varieties. But these are so readily applied that jio further description is necessary. 74 MANUAL OF BANDAGING. CERVICO-ULNAR CRAVAT AND TRIANGLE. Description.—I. A cravat two feet in length. II. A triangle having a base of two feet, and a height of twelve inches. Application.—Tie the cravat a, about the neck. Flex the FlG 54 forearm, at right angles upon the arm; then place the base of the triangle at the ulnar border of the hand, the apex, b, being at the elbow, and tie the two extremities of the tri- angle into the cravat of the neck, as at c Uses.— In cases of burns at the back part of the elbow, or trans- Cervico-Ulnar Cravat and Triangle. ^^ wounds of the front of the joint; also, as a " sling," in cases of injuries of the forearm, or hand, where elevation, or " rest," of the part may seem demanded. It may be applied over the clothing. SPIRAL OF THE ARM. Description.—This bandage should be one and one half yards in length, by one and a half inches in width. Application.—Essentially the same as that of the Spiral of the Forearm, described upon page 71, except that you begin at the elbow. • Uses.— To confine dressings to the arm-regions, or for the support of the edges of longitudinal wounds, thus securing co- aptation. It may or may not be applied with "reverses;" yet, should the biceps be well developed, it would be best to em- ploy them, otherwise the bandage would be in great danger of slipping down.* ♦Note.—See, for all of these Spiral bandages, the description of the Figure of 8 Spiral of the Extremities described upon page 107. BANDAGES OF THE UPPER EXTREMITY. 75 FOUR-TAILED BANDAGE OF THE SHOULDER. Description.—This should be a piece of cloth some forty- eight inches in length, and five or six inches in width. Fold, lengthwise, at the centre, and then cut, or tear, back the ex- tremities to within four or five inches of this point, thus shap- ing it something like the " sling compress," figure 4, page 22. Application.—Place the plane of the bandage over the diseased shoulder, and carry the two superior ends of the ban- dage obliquely down across the chest (one upon its anterior, and the other upon its posterior surface), and tie them below the opposite axilla. Then carry the two inferior extremities of the bandage up around the neck (one in front and the other behind), and confine them by tying. Uses.—To confine dressings about the shoulders. It fur- nishes a very handy, though net very firm, variety of dressing. LARGE OBLIQUE TRIANGLE OF THE ARM AND CHEST. (Large Triangular "Sling" of the Arm.) Description.—A piece of linen, or flannel, folded to the form of a triangle, so that it shall have a base of some sixty inches, and a height of twenty-four. Application.—Having flexed the forearm to a right angle with the arm, fold it to the breast; place the base of the tri- angle, a, at the hand, and pIG 55 carry one end backwards under the axilla of the dis- eased member, to bring for- wards, across the back, to the opposite shoulder,'there to tie with its fellow, b, that ascends directly up- wards, across the front part of the chest, to the same side. The apex of the trian- gle, c, is then to be brought forward, and pinned as you Large Oblique Triangle of the Arm and see in the wood-cut. the chest. 76 MANUAL OF BANDAGING. Uses.—To support the arm and forearm in cases of injury. The cut represents the bandage as being applied over the naked body; it is applied with equal frequency over the clothing. Fig 56. TRIANGULAR FRONT OF THE FOREARM. (The Ordinary Arm-Sling.) Description.—This should be a triangle having a base of forty-eight inches and a height of twenty inches.V The laity usually make it from a large shawl, folded to a wide cravat. Application.—Having flexed the forearm upon the arm, fold it to the chest, and place the middle of the base of the triangle at the hand, a, and conduct the ex- tremities up and around the neck, and confine them by tying. The apex of the triangle can now be folded under the arm to a sufficient extent to have the band- age fit easily, and yet furnish efficient support. Uses.—This, in some measure, takes the place of .the preceding, yet does not fully supplant Triangular Front of the Forearm. T , it. Is used more as a -support of the hand, or lower part of the forearm. This band- age may, or may not, be applied over the naked body. SMALL FRONT OF THE HAND OR FOREARM. (Small Sling of the Hand or Forearm.) Description.—A rectangular piece of cloth eighteen inches long by nine inches wide. BANDAGES OF THE UPPER EXTREMITY. Application.—Flex first the forearm at right angles to the arm, and fold to the chest. Place the middle of the band- age beneath the hand, and fore- arm, carrying both ends up- wards and pinning them to the clothing on the breast, as shown in the cut. Uses.—As a support of the hand, or forearm, in cases of minor injuries. Fig. ~u Small Front of the Hand or Forearm. POSTERIOR DOUBLE FIGURE OF 8 OF THE ELBOW AND THE OPPOSITE AXILLA. Description.—This bandage should be a cravat, two yards in length by eight or ten inches in width. It can be made out of a small shawl, if necessary. Application.—Standing in front of your patient, and hold- ing the bandage with its centre across the palm of the hand, place the centre of the F,G 5s cravat over the elbow, a, of the injured mem- ber, both ends hanging down towards the floor. Seize the innermost ex- tremity and carry it, a, across the inside of the arm, under the diseased axilla, up in front of the same axilla and over the same shoulder, and then obliquely down across the back, b, to the opposite axilla, where you surround the shoulder with the same extremity of the cravat, at last entrust- Posterior Double Figure of 8 of the Elbow and the Opposite Axilla. 78 MANUAL OF BANDAGING. ing it to the care of an assistant. Carry the other extremity of the cravat forwards across the bend of the elbow, and over the other end of the bandage, then backwards, under the dis- eased axilla, as c, and then finally upwards to the opposite shoulder, there confining by tying, after the arm has been suffi- ciently extended backwards. You will then need a " sling," for the horizontal support of the forearm and hand, which can be pinned to the cravat as it crosses the shoulder, or about the neck. (See Figs. 55, 56 and 57.) Uses.—This bandage was designed by Dr. E. M. Moore to take the place of the numerous dressings for fractured clavicle. It dispenses with the " axillary pad," and the more complicated system of Fox and Desault, and seems, from certain anatomi- cal reasons, to be superior to theirs for maintaining a coapta- tion of the clavicular extremities. It certainly has the argu- ment of simplicity in its favor. Fig. 59. SAYRE'S CLAVICULAR PLASTER SPLINT. Description.—Two pieces of adhesive plaster, poroused or plain, each two and one-half inches in width, and two yards in length. Application.—Pass one strip of the adhesive plaster around the arm at the junction of the middle and lower third, making a loop, leaving an open space at the posterior part of the arm, as you see in Fig. 59; this prevents strangu- lation; then draw the arm back, bring- ing the pectoralis major upon the stretch; but the acromial end of the clavicle still rides under the sternal fragment. Now secure the arm back by passing the strip of adhesive plas- ter around the body, bringing it undei the arm of the opposite side, across the thorax, and fasten it to Sayre's Clavicular Splint. 1st Course. BANDAGES OF THE UPPER EXTREMITY. 79 itself on the back. Care must be taken not to draw the arm too far back, but just sufficient to put the pectoralis major upon the stretch. Now take the other strip of adhesive plaster, and make a slight longitudinal cut in the centre, to admit the point of the elbow ; flex the arm at an acute angle over the chest, drawing it upward, forward and inward, in this manner reducing the fracture. Bring both fragments of the bone into a perfect line; you now' secure the arm in this position by passing the strip of adhesive plaster over the elbow, across the back diago- nally to the opposite shoulder, then bring the anterior end of the strip up along the arm and hand over the chest, and fasten it to itself at the shoulder, as shown in Figs. 60 and 61. Fig. 60. Fig. 61. Sayre's Clavicular Splint, finished. Front view of same. Uses.—Professor Sayre claims that it is the most simple method of treating fracture of the clavicle that he has ever seen, and is the only plan of treatment which will yield him a perfect result without deformity. He never uses an axillary pad, as the pressure from this often stops the circulation in the arm, and the pain resulting is sometimes terrible. VELPEAU'S BANDAGE. Description.—A roller 2$ inches in width, and 8 or 9 yards in length. 80 MANUAL OF BANDAGING. Fig. 62. To make a firmer support, ths porous adhesive bandage, as shown in Fig. 62, should be used. Application.—Have the patient place the hand of the injured side upon the opposite shoulder, as, for instance, the left, as shown in the cut. Place the initial end of the band- age under the axilla of the sound side, then carry the roller-head diagonally up across the back to Veipeau's Bandage. the top of the injured shoulder; then down across the clavicle, and over the front and outside of the injured arm, and under the elbow. From here it is to be carried diagonally up, across the chest, to and beneath the axilla of the sound side, covering in the initial end, thus finishing course 1. Course £ is the same as course 1 until you reach the point of the elbow; as soon as this point is reached, you make a hori- zontal turn about the chest, thus finishing courses 2 and 3. Course 4 is identical to course 1, whilst courses 5 and 6 are in line with courses 2 and 3, the only difference being to over- lap each preceding course one-third to one-fourth the width of the bandage, so as to give the whole a firm support to the parts, and cover in the whole of the arm and chest, as shown in the engraving. Uses.—This bandage is employed in dressing fractures of the clavicle, fractures of either the coracoid or acromial pro- cesses of the scapula, and also in luxations of the humerus. CHAPTER IX, BANDAGES OF THE BODY. SPIRAL OF THE CHEST. Description.—This bandage should be nine yards in length, by two inches in width. Application.—Dropping about one yard of the bandage obliquely down across the Fig. 63. chest, from the top ol one of the shoulders, the left, for instance; carry the head of the bandage down the back to a level with the arm-pits. Make now the spiral turns, 2, 3, 4, 5, 6, 7, 8 and 9, about the chest, and at last confine by pinning, as at 10. Carry, now, the free end of the bandage, 11, which you let fall at the begin- Spirai of the Chest. ning of the application, obliquely up over the chest, to the opposite shoulder from whence dropped, and confine, by pinning, to the posterior spiral turns. The spiral courses may be stitched to course 11. TjSes.—This bandage is employed where compression about the chest is needed, as in cases of fractures of the ribs, sternum or vertebrse, or separation of the rib-cartilages; also in wounds of the abdomen with presentation of the viscera. It is also of use in emphysema, or after thoracico-paracentesis, thus com- pressing the walls of the chest, if they be much expanded. [81] 82 MANUAL OF BANDAGING. Variety.—If the roller-head should be carried down to the superior margins of the inferior ribs, and then the circular spirals made, we would have the Spiral of the Abdomen. Full a yard more of bandage is, in this case, required. It can also be extended down upon the abdomen, from the " Spiral of the Chest," by having the bandage as long again as needed for the performance of the chest spiral. The uses of these varieties are similar to those of the above. They are especially appli- cable where abdominal compression is desired, as after para- centesis abdominis, eviscerating wounds, dropsies, ovarian tumors, etc. ADHESIVE SPIRAL OF THE CHEST. As a useful substitute for the flannel "Spiral of the Chest," just described, take an equal sized roller of porous adhesive band- age. It may be applied in a similar manner and will be found to give better fixed support to the chest- walls than will the flannel or cotton roller, hence it would be preferred to them in cases of fracture or luxa- tion of the bones or the car- Adhesive Spiral of the Chest. tilages of the chest-walls. It can be applied lower down upon the body, and would then be a variety of the " Spiral of the Abdomen." , CIRCULAR-QUADRILATERAL OF THE CHEST, AND DORSAL CERVICO-STERNAL TRIANGLE. Description.—I. There should be a quadrilateral wide enough to cover in the thoracic region, and long enough to en- BANDAGES OF THE BODY. 83 circle, one or more times, the body, and may or may not be of several thicknesses. II. A triangle having a base one yard in length, and a height of eighteen inches. Application.—Encircle the body with the quadrilateral por- tion of the bandage, as a, and confine by pins or stitches. This done, place the Fig. 65. centre of the base of the triangle at the nape of the neck, carry the two ends, b, b, forwards and downwards, across the front of the chest, and confine them with pins to the quadri- lateral, or thoracico-en- circling portion. Then carry the apex of the triangle down the back, and pin it to the quadri- lateral portion of the bandage at the back, so as to prevent it slipping down. Circular-Quadrilateral of the Chest, and Dorsal Cervico-Sternal Triangle. Uses.— For confining dressings to any portion of the thoracic regions; also for supporting the walls of the chest, in case of injury or disease, where the respiratory movements are to be confined. Variety.—By widening the quadrilateral portion of the bandage, a, or by dropping it farther down the body, so as to encircle the abdomen, we get the Circular- Quadrilateral of the Abdomen, and the Dorsal Cervico-Sternal Triangle; or, if the "bandage be wide enough to cover both the thoracic and ab- dominal regions, the Circular Quadrilateral of the Abdomen and Thorax, and the Dorsal Cervico-Sternal Triangle. In either of the cases two strips should be passed from the an- terior surface of the quadrilateral to its posterior surface, 84 MANUAL OF BANDAGING. across the perinseum, thus preventing the bandage from slip- ping upwards. The uses of these bandages are to furnish support to the ab- domen, as well as the thorax, after ovariotomy, paracentesis abdominis, or other injuries of the abdominal wall. ANTERIOR THORACICO-SCAPULAR TRIANGLE. Description.—This bandage should be made of a triangle having a base one and one-quarter yards in length, and a height of eighteen or twenty inches. Application.—Place the base of a triangle, a, at the in- ferior and middle portion of the chest. Carry the two ends, Fig. 66. B> b, horizontally about the body, and tie at the back. Then carry the apex of the triangle, c, up across the chest, over the shoulder diseased, and then down to the ends tied at the back, where it is to be confined. Uses.—To retain dressings upon either of the lateral-an- AnteriorThoracico-Scapuiar Triangle, terior surfaces, or the anterior surface, of the chest. Variety.—By placing the base of the triangle at the back, and then similarly applying, you get the Posterior Thoracico- Scapular Triangle, which is useful in confining dressings to either the posterior, or lateral, surfaces of the thorax. FIGURE OF 8 OF THE NECK AND AXILLA. (Spica of the Shoulder.) Description.—This bandage should be made from a roller six yards in length by two inches in width. * BANDAGES OF THE BODY. 85 Application.—Place the initial end of the bandage at the side of the neck, 1; con- Fig 67 fine by a single horizon- tal circular turn, 2. Continue the course of the bandage about the neck, at last crossing down to the axilla from over the back of the shoulder, thus finishing course 3. Course 4 is made by carrying the roller-head up over the Figure of 8 of the Neck and AxiUa" anterior surface of the shoulder, from under the axilla, to the back of the neck. Course 5 is made the same as course 3; course 6, as course 4; course 7, as course 5; course 8, as course 6, and so on. At last exhaust the bandage by a single hori- zontal turn about the neck, and confine as usual. Uses.—To confine dressings to the clavicular, sub-clavicu- lar, and axillary regions; also, upon the shoulder. CRAVAT OF THE NECK AND AXILLA. Description.—A cravat one yard in length. Application.—Standing at the side of your patient, place the centre of the cravat beneath the diseased axilla. Carry, now, the posterior extremity up over the scapular region, across the top of the shoulder, and around over the front of the neck to the opposite side, thus imitating course 7 of the preceding bandage, only making it in the opposite direction; viz., upwards. Then carry the anterior extremity up over the front of the diseased axilla and shoulder to the back of the neck (imitating course 8 of the preceding bandage) to tie with its fellow there. Uses.—Similar to those for which The Figure of 8 of the Neck and Axilla is employed. 86 MANUAL OF BANDAGING. FIGURE OF 8 OF THE SHOULDER AND OPPOSITE AXILLA. (Descending Spica of the Shoulder.) Description.—This should be made from a roller eight yards in length by two inches in width. Application.—Place the initial end of the bandage upon the right arm (supposing it to be the right shoulder that you wish to cover) and confine it by two horizontal, circular turns, 2 and 3, about the arm. Turn 4 is made by mounting up to the right side of the neck (from the back) and pass- ing diagonally down- wards across the chest to the left axilla. Passing under thia axilla, remount to the right side of the neck (across the back), and then descend to the right axilla, thus finishing course 5. Course 6, is similar to that of course 4; course 7, to that of course 5, and so on until the bandage is exhausted, at last con- fine by pinning. Uses.—Is used to maintain dressings upon the shoulder, or acromio-clavicular region, arm-pit, or axilla. Variety.—The Ascending Spica of the Shoulder is applied in a very similar manner, the only difference being that course 4 takes the place of course 14, and course 5 the place of course 13, etc., as shown in the cut; in other words, you ascend grad- ually upwards to the neck. The descending variety is prefer- able, as it gives greater solidity. Figure of 8 of the Shoulder and Opposite Axilla. SIMPLE BI-AXILLARY CRAVAT. Description.—This should be a cravat (a triangle folded to this form) one yard in length. BANDAGES OF THE BODY. 87 Fig. 69. Application.—Place the middle of the cravat in front of the axilla of the diseased side, as a; carry both extremities up- wards over the same shoulder as b, b', there cross- ing them. Then conduct that ex- tremity which passes over the front of the axilla, b, back- wards over the shoulder and the back, tO the Op- Simple Bi-axillary Cravat. posite axilla, and tie to the other extremity, b', that has been passed somewhat obliquely across the breast, as at c After- wards pin one to the other at the crossing-point, d. Uses.—To confine dressings about the axillary region and shoulder; also for bringing the shoulder forwards upon the chest, in cases of wounds at the front of the part, or of burns upon the posterior, or scapular regions where vicious cicatriza- tion may be feared. COMPOUND BI-AXLLLARY CRAVAT. Description.—This bandage is made from two cravats, each being one yard in Fig 7() length, and made simi- larly to the Simple Bi-axil- lary. Application.— Placing one of the cravats, the centre, beneath one axilla, the right, for instance, conduct the two ends upwards and tie at the shoulder, as A. Place, Compound Bi-axillary Cravat. 88 MANUAL OF BANDAGING. now, the other cravat, beneath the opposite axilla, carry one extremity forwards, obliquely upwards, across the chest, and the other obliquely upwards across the back, to the opposite shoulder, passing one end through the noose made by the cra- vat, a, first applied, and confine by tying, as at b. Uses.—Similar to the above. It also affords means for confining dressings to both axillary regions simultaneously. Fig. 71. CROSS OF ONE MAMMA. Description.—This bandage is made from a roller eight yards in length by two inches in width. Application.—Place the initial end of the bandage, 1, be- low the diseased gland, the left for example, and confine by a horizontal circular turn about the body, 2. Con- tinue around the body till you come to a point be- low the diseased mamma, when you ascend obliquely across the chest to the op- posite shoulder (the right in this case), thus finishing course 3. Course 4 is a horizontal circular turn about the body, in line of courses 1 and 2; whilst course 5 is similar to that of course 3. Continue in the same manner till the band- age is exhausted, when you Cross of One Mamma. confine it by pinning, as usual. Uses.—As a " sling," or support for an inflamed or sup- purating breast; and also for exercising a compression upon the gland, when occasion may demand it. In this last case it BANDAGES OF THE BODY. 89 should be applied with considerable firmness, so that the direct benefit from continuous pressure may be obtained. An American surgeon has taken advantage of the expansi- bility of sponge in main- Fig. 72. taining compression of the Mamma. The sponge (a large one) is thor- oughly cleansed and im- pregnated with some an- tiseptic and then pressed between two flat sur- faces until it becomes dry, and as flat as possi- ble. It is then firmly strapped or bound upon the breast with some one of the breast bandages which have been de- Porous Adhesive Cross of the Mamma. scribed, and is gradually made to expand, by moistening with water, if the secretions from the gland or sore be not sufficient for this purpose. Variety.—The Porous Adhesive Cross of the Mamma. This is shown as applied to the patient in Fig. 72. The des- cription and application is similar to that of the non-adhesive Cross just described. Note.—This porous adhesive bandage adheres but slightly to the integument; is reversible, hence it is to be preferred to the ordinary Adhesive Plaster Roller. It does adhere, how- ever, to itself, hence furnishes much firmer support than does the flannel or cotton roller. Being perforated, it also adapts itself more evenly to the contour of the gland, and also permits egress for the discharges when crossing over a wounded sur- face. It was first introduced to the profession by Grosvenor & Richards, manufacturers of Surgical and Medicinal Plasters, Boston, Mass. 90 MANUAL OF BANDAGING. TRIANGLE OF THE MAMMA. Description.—This should be made from a triangle having a base one yard in length and a height of eighteen inches. Application.—Placing the base of the triangle, a, at the xiphoid cartilage, carry one end obliquely up over the opposite shoulder, b, and the other end, b', below the axilla of the diseased side, and tie them together at the back. The apex of the triangle, c, is then to be carried upwards over the shoulder of the dis- eased side, and confined to the extremities of the tri- Triangle of the Mamma. angle, at the back. Uses.—Similar to the preceding; but it is more especially adapted than it for retaining cataplasms and other dressings to the gland, and the region about it; is more easily applied than the above, and makes an excellent suspensory bandage for the mamma. BOURSE OF THE MAMMA. Description.—A piece of lint ten inches in length, and Fig. 74 eight inches in width when folded at the centre. Cut off, then, the folded corners, a and b, by the dotted lines o-d, and e-f; stitch, then, the whole together from g to f; viz., g-o-d-e-f. This done, to each of the two corners at g, and the two at h, stitch a narrow strip sufficiently long to meet and tie, with its fellow (the two inferior), about the body, and (the two superior) about the neck. BANDAGES OF THE BODY. 91 Application.—Introduce the diseased gland into the bourse a, carry the two ends, b and b', around the neck, the one on one side, and the other on the other, and confine them by tying ; con- duct, now, the two inferior ends, c and c', horizontally about the chest, and tie them either there, or, after crossing them, bring forwards, and tie in front. Uses.—As a suspensory of the gland in cases of hypertrophy, or extreme flaccidity. Also use- ful in confining cataplasmata, or other dressings. Bourse of the Mamma. CROSS OF THE TWO MAMM^J. Description.—This bandage should be made from a roller twelve yards in length by two inches in width. Application.—Place the initial end midway between the lower extremity of the xiphoid Fia> ^ cartilage and the umbilicus, and, going from right to left, confine it by a single horizon- tal turn, 2. Continue in the same course, till you come to the right side of the chest, when you mount obliquely upwards across the chest, to the left shoulder, thus finish- ing course 3. Course 4 is a horizontal turn about the chest. Continue about the body, horizontally, till you get to the left scapular region, when you mount obliquely upwards across the back, to the right side of the neck, and then descend obliquely downwards, across the front of the chest, below the left mamma, thus Cross of the Two Mammro. 92 MANUAL OF BANDAGING. finishing course 5. Course 6 is made similarly to course 3; course 7, to course 4 ; course 8, to course 5 ; course 9, to course 6 ; course 10, to course 7 ; course 11, to course 8 ; course 12, to course 9 ; and so on until the roll is exhausted, when you confine as usual. Uses.—In case of disease of both breasts where suspension is required; also for compression, and for the retaining of dress- ings. It is not a very stable bandage, besides being open to the objection of somewhat cording the neck. For retaining topical dressings, or for suspension, the triangular mammary bourse, see figure 75, would be preferable. Note.—Mayor's system may be used in making this bimam- mary bandage by simply applying the Triangular Caps of the Mammae, one to each gland; the two apices being confined, as described upon page 90, or else tied or pinned together. This would then be known as The Bimammary Triangle. Two Bourses may also be employed; each being made and applied similarly to that one described upon pages 90 and 91. POSTERIOR FIGURE OF 8 OF THE SHOULDERS. (The Posterior "Star" Bandage of the Old Authors.) Description.—This bandage is made from a roller, eight yards in length by two inches in width. Fig, 77. Application.—Place the initial end, 1, at the middle and posterior part of the left arm. Confine it by two circular turns about the arm, 2 and 3. Continue in the same course till you reach the anterior sur- face of the arm, when you ascend obliquely Posterior Figure of 8 of the Shoulders. across the axilla and BANDAGES OF THE BODY. 93 chest to the left side of the neck; from here you descend obliquely across the back, to and beneath the right axilla, thus finishing course 4. Carry the roller under this axilla up to the top of the same shoulder, and obliquely down across the back to the left axilla, thus finishing course 5. Course 6 is made similarly to course 4; course 7, to course 5; course 8, to course 6; course 9, to course 7, and so on until the bandage is exhausted, when you confine as usual. Uses.—For retaining dressings upon either the anterior or posterior surface of the chest; for fixing the shoulders back- ward, in case of burns of the chest, or in backward displacement of the sternal end of the clavicle, and also for assisting in holding in coaptation the ends of a broken clavicle, or clavicles. Also of use in luxations of the acromial end of the clavicle. It is necessary to have considerable cotton-wool, or some like substance, in the axillae, in order to guard against chafing of the parts. SIMPLE DORSAL BI-AXILLARY CRAVAT. Description.—This bandage is made from a cravat one and one-half yards in length. Application.—Place the middle of the cravat across the inter-clavicular space, a. Carry Fig. 78. one extremity down below one axilla, the right for example, and up over the same shoulder, b. Carry the other extremity up over the other shoulder, b', down in front of and beneath the same axilla ; at last confine it to the other extremity, after you have sufficiently extended the shoulders backwards. Simple Dorsal Bi-axillary Cravat. Uses.—This bandage of Mayor takes the place of the preceding, and may be preferred to it for its simplicity. 94 MANUAL OF BANDAGING. COMPOUND DORSAL BI-AXILLARY CRAVAT. Description.—I. A cravat one yard in length. II. Another cravat two feet in length. Application.—Tie the shortest cravat about one of the FlG 79 shoulders, the left for example, as at a. Now place the centre of the other cravat in front of the opposite axilla (the right in this case), and carry one end up over the same shoulder (the right) and the other be- neath the same axilla, to the back. Carry, now, the superior extremity through the noose formed by the cravat first ap- Compound Dorsal Bi-axiiiaryCravat. plied; then twist the other ex- tremity about this one, as at b and c, and finally tie as at d. Uses.—The same as the Simple Dorsal Bi-axillary Cravat, and the Posterior Figure of 8 of the Shoulders. This is a very powerful bandage, and the arm-pits need to be well padded. Variety.—Take three cravats, two of them being, each, about two feet in length, the remaining one something short of this. Tie one about each shoulder. Then tie the third one through the nooses formed by the first two, so as to bring the two together at the back, thus taking the place of the single noose, b, c, d, of the preceding cut. If there is danger of either of these bandages slipping from the shoulder, a cravat might be tied across the breast, from one to the other, similar to that at the back, thus effectually preventing such a mis- chance. ANTERIOR FIGURE OF 8 OF THE SHOULDERS. (Anterior "Star" Bandage.) Description.—This bandage should be eight yards in length by two inches in width. BANDAGES OF THE BODY. 95 Fig. 80. Application.—Place the initial end, 1, at the front of the middle of the right arm, and confine by two horizontal circular turns, 2 and 3. Continue in the same course till you reach the posterior surface of the arm, when you mount up over the shoul- der of the same side then cross diagonal- ly downwards to the left axilla, thus finishing course 4. Pass the roller-head Anterior Figure of 8 of the Shoulders. beneath this axilla, up over the same shoulder, and diagonally down across the front of the chest to the right axilla, thus finishing course 5. Conduct the bandage under this (the right) axilla, and then upon the right shoulder, and diagonally down across the front of the breast to the left axilla, thus com- pleting course 6. Course 7 is made similarly to course 5; course 8 to course 6; course 9 to course 7, and so on. At last exhaust the bandage, and confine either by pinning or stitch- ing to the other courses. Uses.—In cases of fractures of the sternum, or separation of the sternal cartilages; also in cases of burns on the inter- scapular regions, when vicious cicatrization is to be feared. Might be of use in some clavicular dislocations. As in all of the axillary bandages, this one needs a thorough protection of the axillae by cotton-wool in order to prevent chafing of the parts, especially the posterior portion. SIMPLE STERNAL BI-AXILLARY CRAVAT. Description.—This bandage is made from a cravat one and one-half yards in length. 96 MANUAL OF BANDAGING. Application.—The opposite to that of the Dor3al Cravat,. described upon page 93, this one being applied across the chest instead of the back. Uses.—Similar to those for which the preceding is em- ployed. COMPOUND STERNAL BI-AXILLARY CRAVAT. Description.—Two cravats, one one yard in length, the other two feet in length. Application.—Opposite to that of the Compound Dorsal Bi-axillary Cravat, described upon page 94. This one being applied across the chest. Uses.—Same as the Anterior Figure of 8 of the Shoulders. Variety.—Prepare three cravats, two of them being two feet in length, the third one not quite so long. After tying one of the longer ones about each shoulder, tie the remain- ing one into the nooses formed by the other two, across the front of the chest. A fourth cravat is now necessary to pre- vent those fastened about the shoulders from slipping forward? and off these parts, and is to be tied to them across the back CHAPTER X. BANDAGES OF THE LOWER EXTREMITY. SPIRAL OF ONE TOE. Description.—This should be made from a roller four feet in length by three-quarters of an inch in width. Application.—This is so similar to that of the Spiral of One Finger, described upon page 60, figure 40, that no further discussion is necessary. Uses.—For injuries to the toes, similar to those of the fin- gers for which the spiral is there used. FIGURE OF 8 OF ONE TOE. (Spica of the Toe.) Description.—This bandage should be made from a roller, two yards in length by three-quarters of an inch in width. Application.—Similar to that of the Figure of 8 of the Thumb and Wrist, or Spica of the Thumb. See figure 41, page 61. Uses.—Of a similar use to that of the Spica of the Thumb. ADDUCTOR BANDAGE OF THE BIG TOE. Description.—The bourse may be cut from the " thumb " of a buck-skin or a dog-skin glove. To this, on one side, stitch a piece of elastic ribbon. To this elastic ribbon attach also a strip of ordinary adhesive plaster; one that is long enough to reach around the foot. II. Two other smaller strips of adhesive plaster of sufficient length to surround the foot, as shown in the cut. r97l 98 MANUAL OF BANDAGING. Fig. 81. Application.—Supposing it is the pollex of the right foot that is to be treated, the bourse is to be applied over the toe, the member being acfaucted as much as possible, and the strip, with the adhesive plaster and webbing, is then carried firmly along the inside border of the foot, around back of the heel, down the outside foot-border to the little toe, and there confined. The shorter pieces of adhesive plaster are then placed around the foot, one in front of the ankle, the other over the meta- tarsal region, thus confining the webbing more securely. Uses.—This dressing was de- vised by Dr. Chas. H. Lathrop, of Lyons, Iowa, for the cure of bunions on the joint of the large toe. It is equally service- able as a dressing after separation of adhesions of the toe- cleft, or to prevent vicious cicatrices at this point. Adductor Bandage of the J»ig Toe. DOUBLE T OF THE TOES AND ANKLE. Description, Application and Uses are so similar to the Double X °f the Back of the Hand and Wrist, that a refer- ence to it, figures 43 and 44, pages 63 and 64, will be sufficient/ for its application to the foot. SPIRAL OF ALL THE TOES. (Gauntlet of the Foot.) Description.—This bandage should be ten yards in length by three-quarters of an inch in width. Application. —Similar to the Gauntlet of the Hand. figure 48, page 67. See BANDAGES OF THE LOWER EXTREMITY. 99 Uses.—Similar to those of the Spiral of All the Fingers just referred to, only in cases of diseases or injuries of the foot. FIGURE OF 8 OF THE FOOT AND ANKLE. Description.—This should be a roller two and a half yards in length by one and three-quarters inches in width. Application.—Place the initial end, 1, at the front of the leg, a few fingers' breadth above the Yig. 82. ankle, and confine it by the hori- zontal circular turn, 2. Continue in the same course till you come to the inner malleolus again, sup- posing it to be the left foot that you are dressing, when you descend obliquely across the dorsum of the foot, to the fifth metatarsus, thus completing course 3. Make, then, a circular turn about the metatarsal bones (course 4), coming obliquely across the dorsum of the foot, from within outwards, to the outer malle- olus, thus completing course 5. Course 6 is made similarly to course Figure of 8 of the Foot and 3, course 7 to course 5, and so on. An le" At last exhaust the bandage by circular turns about the lower portion of the leg, and confine in the ordinary way. Uses.—For confining dressings either to the dorsum of the foot, or to the surface contiguous to the malleoli. Also for compression, after venesection from one of the dorsal veins of the foot; a graduated compress would be necessary in this case. SPIRAL OF THE FOOT. This bandage is but a part of the Reversed Spiral of the Inferior Extremity, and will be sufficiently described when we come to treat of that dressing. See page 110. 100 MANUAL OF BANDAGING. TRIANGLE OF THE FOOT. Application.—A triangle with a base two feet in length, and a height of ten inches. Description.—Place the base of the triangle obliquely across the front of the ankle, a, and Fig. 83. . ' ' carry the superior end, b, around the lower part of the leg, and confine. Conduct the inferior extremity about the metatarsophalangeal bones and pin, as at c\ Then conduct the apex of the bandage about the heel, and pin as at c. Uses.—To confine dressings either to the dorsum or the sole of the foot, to either of the malleoli, or regions- adiacent, or to the calcanean region. Triangle of the Foot. , P , , or the lower part of the leg. FOUR-TAILED BANDAGE OF THE INSTEP. (Sling of the Instep.) Description.—This should be a strip of cloth eighteen inches in length, and four inches, or more, in width, cut to a four-tailed bandage, as seen in the compress of four heads (fig- ure 4). Application.—Place the centre of the bandage at the in- step, and carry the two superior ends around the lower part of the leg and tie them; then carry the two inferior ends around the tarsal portion of the foot, and tie also. Uses.—To confine cataplasmata, and other dressings, to the instep, lower front portion of the leg, and the tarsus. FOUR-TAILED BANDAGE OF THE HEEL. (Sling of the Heel.) Description.—A strip of cloth eighteen inches in length, and four or more in width, and torn to a four-tailed bandage. BANDAGES OF THE LOWER EXTREMITY. 101 Application. —Place the body of the bandage at the heel and carry the two superior ends around the lower portion of the leg, and confine. The two inferior ends are then to be carried about the tarsus, and also tied. Uses.—To confine dressings to the calcanean region. SHEATH OF THE FOOT. Instead of the more elaborate bandage proposed by some surgeons, an equally efficacious bandage, and certainly easier obtained, is a common "stocking." Is used as a retainer of cataplasmata to the toes or foot. Fig. 84. POSTERIOR FIGURE OF 8 OF THE KNEE. Description.—The roller should be four yards in length by one and three-quarter inches in width. Application.—Placing the initial end of the bandage, 1, at a point some- what above the popliteal space, confine it by a horizontal turn of the bandage, 2. Continue in the same direction, passing over the front of the thigh, till you come nearly to the posterior sur- face again, where you descend, ob- liquely, across the popliteal space to the opposite border, thus finishing course 3. Course 4 is a horizontal turn about the upper part of the leg ; while course 5 ascends obliquely across the popliteal space to the opposite lateral border. Course 6 is in line of course 3 ; course 7, of course 5, and so on. Having exhausted the ban- dage, after covering-in the popliteal space, confine in the ordinary way. Uses—To confine dressings to the popliteal space; or, with the aid of a graduated compress, to exercise compression upon an aneurism at this point. Posterior Figure of 8 of the Knee. 102 MANUAL OF BANDAGING. THE POPLITEAL CRAVAT. Description.—A cravat some four feet in length. Application,—Place the centre of the cravat, a, at a point just above the popliteal space, and carry the two ends hori- Fig. 85. zontally forwards about the thigh; cross them, and descend obliquely across the space, b, b', crossing one above the other there; carry them now horizontally for- wards about the upper portion of the leg, crossing them below the patella, to con- duct them to the posterior surface of the leg, confining by tying, as at c. Uses.—This bandage fulfils the same The Popliteal Cravat. indications as the above. ANTERIOR FIGURE OF 8 OF THE KNEE. Description.—A roller four yards in length by one and three-quarters inches in width. Application.—Essentially the same as that of the Posterior Figure of 8 described upon page 101, only remembering that it is to the anterior surface of the limb that you are applying the bandage. Uses.—To aid in supporting the patella, when fractured; to compress an effusion into the joint, and to confine various dressings thereon. CRAVAT OF THE KNEE. Description.—A cravat some four feet in length. Application.—Place the centre of the cravat, a, see figure 85, page 102, above the patella, and carry the two extremities backwards and cross them, and so bring diagonally down across the front of the patella, in a measure similar to that seen in The Popliteal Cravat just referred to. The other BANDAGES OF THE LOWER EXTREMITY. 103 courses of the bandage are made similarly to the correspond- ing courses of this popliteal dressing. Uses.—As an approximator of the fragments of a fractured patella, and for "steadying" the motions of the joint, or con- fining loose dressings thereon. TESTUDO OF THE KNEE. (Roller Cap of the Knee.) Description.—A roller eight feet in length by one and three- quarter inches in width. Application. —Place the initial end of the bandage, 1, below the patella, and confine by a Fl(J g6 single circular turn, 2. Continue in the same course with the bandage, making an ascending spiral course for turn 3. The roller-head is now carried upwards across the popliteal space, above the femuric condyles, and made to take the descending spiral course 4, to finish this turn of the bandage. It is then carried downwards across the popliteal space, so as to be in readiness to make the ascending spiral course 5. Course 6 Testudoof the Knee. is made similarly to course 4; course 7, to course 5, and so on, gradually "drawing in" the bandage till the patella is entirely covered, when you either confine, or else go on to finish the bandage as a spiral of the thigh. Uses.—To confine dressings about the knee-joint, to exer- cise compression thereon in cases of synovitis, or to steady the joint and prevent motion in cases of other injuries of the leg. Is frequently made use of in the Spiral of the Inferior Ex- tremity, when covering in the knee-joint. Variety —Instead of the alternate upward and downward spiral courses being used, a bandage, fulfilling the indications of the above, may be made by the use of continued ascending 104 MANUAL OF BANDAGING. spirals about the member. This is the form most generally made use of in applying the Spiral of the Inferior Extremity, and is seen in the figure of that bandage on a following page. It is known as The Spiral of the Knee. Fig. 87. FOUR-TAILED BANDAGE OF THE KNEE. Description.—A strip of linen or cotton, from eight to ten inches in width, and one yard in length. Each end to be torn back (at its centre) to within eight inches of the middle of the bandage. Application.—Place the plane of the bandage, a, over the patella, and carry the superior ends of the bandage around the lower'part of the thigh, crossing them to remount the member, b, to tie in front. Then conduct the two inferior extremities in a similar manner about the upper portion of the leg, d, to finally confine by tying below the patella. Uses.—To confine cataplasmata or vesicants upon the patellar region. It can also be made use of to approximate the patellar fragments, when the bone is fractured; or, with the aid of com- presses, to exercise compression, in cases of chronic synovitis. Four-tailed Bandage of the Knee. SANBORN'S SPLINT FOR THE PATELLA. Fig. 88. Sanborn's Splint for the Patella.—1st Stage. BANDAGES OF THE LOWER EXTREMITY. 105 Description.—I. A strip of adhesive plaster three or four feet in length, by three inches in width. II. A roller bandage, or what makes a preferable dressing, the perforated adhesive bandage, eight feet in length, by two inches in width. Application.—The strip of plain adhesive plaster is to be first applied to the front of the thigh and leg, as shown in Fig. •88, with a loop over the injured patella. This strip of plaster is then to be confined to the member, as shown in Fig. 89, which is virtually the " Reversed Spiral of the Inferior Extremity." Fig. 89. Sanborn's Splint forth.e Patella.—2d Stage. After the plaster strip is thoroughly confined by the bandage, a firm compress, as a small roll of the adhesive bandage itself, is then to be placed above the fractured and separated bone, as shown in Fig. 89 ; also another beneath the lower edge of the inferior fragment. This done, a stick is to be thrust through the loop left by the adhesive plaster, and this loop twisted by the stick till the separated parts of the bone are brought into apposition, when the whole is to be confined. Uses.—To support the portions of a fractured patella. Variety. A slight modification of the apparatus here shown would, with a wire frame about the thigh, form an excellent modification of "Smith's Anterior Splint" for a fractured femur. 106 MANUAL OF BANDAGING. HAMILTON'S SPLINT FOR FRACTURED PATELLA. Fig. 90. Hamilton's Splint for Fractured Patella. Fig. 90 shows the adhesive bandage as applied to the lower extremity, to retain the pieces of the patella in position when transversely fractured, according to the method of Prof. Frank H. Hamilton. This variety of bandage will be found to give better support than will the ordinary flannel or cotton roller in this surgical dressing. The other various forms of fracture dressing—zinc or tin splints, plaster casts, etc.,—can be equally well confined in this manner, altering, of course, the arrangement of the courses of the bandage, or plaster strips, to conform to the various dress- ings and members the bandage is calculated to support. SIMPLE SPIRAL OF THE LEG. Description.—This bandage is made from a roller four yards in length by two inches in width. Application.—Beginning at the ankle, make a simple circular turn about the member, thus confining the initial end of the bandage. Then continue the turns of the bandage spirally about the member (omitting the reverses) as seen in turns 15, 16 and 17 of the figure accompanying the Spiral of the Inferior Extremity. At last confine as usual. Uses.—For maintaining pressure upon the parts covered, BANDAGES OF THE LOWER EXTREMITY. 107 or for retaining dressings thereon. Is not a very stable band- age should the musculi gastrocnemius et soleus be well devel- oped. Variety.—This bandage may be applied to the thigh ; it then becomes The Simple Spiral of the Thigh. The starting point, in this case, being at the knee. REVERSED SPIRAL OF THE LEG. Description.—A roller eight feet in length by two inches in width. Application.—This is but a part of the bandage described under the head of The Reversed Spiral of the Inferior Extrem- ity, and will be sufficiently described when treating at that bandage. See figure on page 110. Uses.—This makes a very stable sort of dressing, and is to be employed, in most cases, in preference to the preceding bandage, as it is not so liable to slip down and out of place. Variety.—This bandage may be equally well applied upon the thigh, starting at the knee. It is then known as The Re- versed Spiral of the Thigh. THE FIGURE OF 8 SPIRAL OF THE EXTREMITIES. Description.—This bandage is a Fig. 91. double spiral, and needs for its ap- plication a roller-bandage ten yards in length by two inches in width. Application.—Place the initial end at the roots of the toes, confin- ing by a single spiral turn about the foot, and cover the foot as in the Spiral of the Inferior Extrem- ity, by reverses and figures-of-8. Having reached the leg, one turn and a half is made before a reverse is used. Thus the reverse is em- The Figure of 8 Spiral of the ployed on the second turn of an ordi- Extremities. nary spiral instead of upon the first, as in the simple spiral 108 MANUAL OF BANDAGING. with reverses. This process of reversing upon each second turn from the last reversement is pursued up the entire limb. Hence, course 9 is a simple spiral, whilst course 10 is a spiral with a reverse. Course 11 is completed as an upward spiral about the limb, with no reverse, whilst course 12 would be a reversed spiral, coming from above downwards, across the front of the limb. Course 13 is similar to course 11; course 14, to course 12, and so on until the bandage is exhausted. This makes, then, a Figure of 8 Spiral of the Extremities with alternate reverses. Uses.—Similar to those for which the Simple and the Re- versed Spirals are employed, and may be used on either the upper or lower extremity. It makes a very secure method of dressing, and gains this advantage through this fact: that the superficial courses (the reversed ones) rest upon cloth, and not upon the slippery integument, as in the case of the other bandages. The same advantage might be gained by covering an ordinary spiral with a second bandage,—an ordinary reversed spiral. This variety of the spiral bandages is especially useful in piaster-of-Paris, starch, or other so-called immovable dressings; also in fractures, or other cases where extension is demanded, and where a long interim between dressings is desirable. Variety.—If the bandage is composed of very extensible material, as very thinly woven flannel, so as to be easily " moulded to a part," it may be made throughout without a S|2 Sh^fl I sin9le reverse. Each course of the If^flBSi Ivfl bandage would then be a single figure-of-8 about the limb; thus, turns 7 and 8 would be simple circles of the limb; turn 9, an upward spiral, turn 10, a downward spiral, turn 11 an up- ward spiral again, overlapping turn 9; turn 12, a downward spiral, overlap- ping turn 10, and so on until the limb is sufficiently encompassed. Figure of 8 Bandage of the . J r Extremities. This also makes quite a firm dress- Fig. 92. BANDAGES OF THE LOWER EXTREMITY. 109 ing, as the superficial courses of the bandage rest upon flannel, and not upon the integument. It is used in cases similar to the preceding. It is known as the Figure of 8 Bandage of the Extremities, and can be applied, as its name indicates, to'either the inferior or superior, extremities. TRIANGLE OF THE LEG. Description.—A triangle one yard in length at the base, and eighteen inches in height. Application.—Place the base of the triangle, a, obliquely across the front of the leg, and carry the superior extremity around below the pa- tella, and confine with a pin, b. Then conduct the inferior extremity around the lower part of the leg, and also con- fine it, c. Then carry the apex of the triangle around the "calf" of the leg, also confining it with a pin, as at d. Uses.—Useful in confining dressings to the parts it covers, and also for main- taining compression, when this may be required. Variety.—This bandage may be ap- plied to any part of the leg, or even to Tri<"igieof the Leg. the arm and forearm, fulfilling similar indications in diseases or injuries of those parts. FOUR-TAILED BANDAGE OF THE LEG. Description.—A piece of cloth wide enough to sufficiently cover the diseased portion of the member. This is then to be cut back, at the ends, to near its centre, as you see in the com- press (figure 4), upon page 22. Application.—The plane of the bandage is to be placed over the calf of the leg, and the two superior ends carried forwards, and around the leg, below the patella, and confined. The two 110 MANUAL OF BANDAGING. inferior ends are then to be conducted about the lower portion of the leg, and also confined by tying. Uses.—To confine cataplasmata, or other dressings, upon the gastrocnemial and soleal region. REVERSED SPIRAL OF THE INFERIOR EXTREMITY. Description.—This bandage is made from a roller eighteen yards in length by two inches in width. Application.—Place the initial end of the bandage at the Fig. 94. metatarso-phalangeal articulation, and con- fine by two circular turns about the foot at this point. Continue on about the foot in the same manner, only making a reverse at each course of the bandage, until the ankle is reached, as you see in the wood-cut. Or, it is sometimes best to make the last two or three turns about the foot and ankle in figure-of-8's, as you see in wood-cut number 82, page 99. It is also often neces- sary to fill up the hollows about the ankles with cotton-wool. Having got so far in the application of the bandage, make three or four spiral turns about the lower part of the leg, courses 15, 16, 17, 18 in the figure, before you begin the reverses about the leg—courses 19 to 30 inclusive; you then come to the knee, which may be cov- Re versed Spiral of the i.imim.-in «« -~~ inferior Extremity. ered in by The 1 estudo, figure 89, page 103, or the simple spiral turns, 31, 32, 33, 34 and 35 in the cut. Having cleared the femuric condyles, you then make spiral re- verses to the hip, where you confine the bandage in the usual way. Uses.—For all the multitudinous purposes that such an in- jured or diseased member may demand. The same caution should be observed here as was spoken of under the Reversed Spiral of the Superior Extremity, page 72. BANDAGES OF THE LOWER EXTREMITY. Fig. 95. Variety. — As a variety of the " reversed spiral " of the inferior ex- tremity, you have the bandage shown in Fig. 95. This is made from the Perforated Adhesive Bandage of Grosvenor & Richards. It is to be applied in a similar way to the ordi- nary " roller " just described ; the only difference being that the band- age will not need to be as long, as the several turns do not need to overlap each other as much as when the non- adhering bandage is employed. This is much better than adhesive plaster, as the plaster would adhere to and irritate the skin. Then, too, the non- porousness of the adhesive plaster would allow more sweating of the limb than does the perforated band- age here shown. This makes a much firmer support than does the ordinary roller of cotton or flannel. Perforated Reversed Spiral of Inferior Extremity. RECURRENT FOR AMPUTATED THIGH. Description.— This bandage Fig. 96. Bhould be twelve yards in length by one and three-quarter inches in width. Application.— Place the initial end, 1, upon the front of the thigh, and confine by three horizontal cir- cular turns, 2, 3 and 4. Continue the course of the bandage about the limb, horizontally, finishing turn 5 at the lateral border of the member. Reverse the bandage at a right angle, and continue course 6 down the limb, across the Stump, then up to the fourth Recurrent for Amputated Thigh. 112 MANUAL OF BANDAGING. course of the bandage, thus finishing turn 6. Reverse, now, the bandage at a right angle again, and encircle the member for turn 7, finishing it, anteriorly, at the middle of the limb, as course 8. Continue the bandage on in the same course to finish turn 9 upon the member's anterior surface. Again you reverse at right angles, and carry the bandage longitudinally down the limb and across the stump, thus making the tenth course of the bandage. The remaining courses of the bandage are applied similarly to those just described. At last, when the stump is covered, and the bandage exhausted, confine in the usual way, by pinning. Uses.—For confining dressings to a " stump." Is somewhat " tedious " of application, and hence the two following band- ages are to be preferred to it. Variety.—This bandage is equally applicable for any stump of the leg, or of the upper extremity. It would then be of the same width, but somewhat shorter. It would then be known (from its respective uses) as The Recurrent for an Amputated Leg; The Recurrent for an Amputated Forearm; The Recur- rent for an Amputated Arm. A somewhat similar Recurrent has been devised for a hip-joint stump, and also for a shoulder- joint stump. The same objection holds good against these bandages, as the one just described, viz: rather more ornate than useful. TRIANGLE FOR THIGH STUMP. Description.—This should be a triangle having a base one yard in length, and a height of eighteen inches. Application.—Place the middle of the base of the triangle, a, upon the anterior surface of the thigh, at a proper distance from the cut sur- face ; carry the two extremities Triangle for Thigh stump. backwards about the member, and BANDAGES OF THE LOWER EXTREMITY. 113 bring them forwards, after crossing them, to pin at the front, b and c Carry, then, the apex of the triangle directly across the stump and up the posterior surface of the limb, pinning to the crossed extremities, b and c Uses.—This is a very convenient bandage for protecting a stump from injury from clothing and the like, and also for confining cataplasmata. Variety.—By varying the size of the triangle, it can be applied to any stump of either the upper or lower extremity. It would then be known as The Triangle for Leg Stump, The Triangle for Arm Stump, etc., according to the part upon which it might be applied. MALTESE CROSS FOR THIGH STUMP. Description.—I. A piece of lint, or cloth, sixteen inches square, cut to the form of a Maltese cross, see Fig. 7, page 25. II. A roller two yards in length, by two inches in width. Fig. 98. Application.—Place the centre of the cross, a, over the centre of the stump, and fold the edges over each other, b and c, as you see in the wood-cut, so that they may lie as smoothly as possible. Then con- fine with the roller by the use of circular turns about the limb, using reverses, if need be. Maltese Cross for Thigh Stump. Uses. — Similar to the Stump- triangle, and equally useful and easy of application. Variety.__By varying the size of the cross, and the roller, this bandage is equally applicable for any stump of either ex, tremity. It makes most an excellent dressing for hip or shoul- der-joint stumps. It would then be T7ie Maltese-cross for Leg Stump, The 3faltese-cross for Arm Stump, etc., according to the uses for which it is employed. 114 MANUAL OF BANDAGING. CAPUTINA, (Rosette Stump Dressing.) Description.—Take from nine to fifteen strips of cloth (ac- cording to the size of the stump), having each one one and three-quarter inches in width, by two and a-half feet in length. Fig. 99. These strips are to be Diagram of the caputina. together at their centers, though this is not necessary. The whole bandage is then spread upon a newspaper. The horizontal strip, c, of the rosette is laid upon the first piece of the parallel strips (so that the set of parallels becomes but an extension of the rosette), and fastened to it. The object of spreading it upon the paper is only for convenience in carrying and handling. Application.—The stump is now made ready for this final bandage. The centre, a, Fig. 99, placed opposite the medium line of the under surface of the stump, at a point some six inches from its end, and confined there by the long cross strip, c-c, which encircles the member. The remaining portions of the rosette are then laid, smoothly and successively, over BANDAGES OF THE LOWER EXTREMITY. 115 the stump, covering the end com- Fig. 100. pletely. The bandage is then finished by passing the horizonta parallel strips, b, over the remain- *ng portion of the limb, securing the free ends of the rosette that are folded over its anterior surface, thus completing the dressing which is represented, as applied to a thigh-stump, in figure 100. These parallel strips may be used more or less extensively upon the limb, as the exigencies of the case may seem to demand. This bandage is really but the ex- tension of the principle of that of Scultet's, the whole upper portion, b, Fig. 99, being but the bandage of Scultet. . Uses.—This bandage is used only in the dressing of stumps; and it is particularly valuable where pressure is required,—as when the flaps retract, making the wound gape, and thus leav- ing the bone exposed. In its application the stump needs be lifted but once, i. e., when the bandage, lying upon the paper, is first slipped under—a desideratum wanting in all other stump-dressings. Caputina Applied. TARSO-PATELLAR CRAVAT. Description.—I. Two cravats, each one yard in length. II. A third cravat one-half the length of the others. Application.—Tie the smallest of the cravats about the in- step, as a. Take, then, one of the remaining, place its centre, b, above the patella, and carry both ends backwards around the lower portion of the thigh, crossing them at the back, and bringing them diagonally dQwnwards and forwards, below the patella, there tying. Take, then, the third cravat and carry it through to its centre, c, the " stirrup " formed by the one first 116 MANUAL OF BANDAGING. Fio. 101 Tarso-patellar Cravat. applied, a, and conduct each extremity, one upon each side of the leg, up and under the loops of the one applied at the patella, b. Flex the foot, to a sufficient degree, upon the leg, and then, fasten the cravat last applied by pinning the extremities. Uses.—Mayor proposed this bandage for cases of knee-pan fractures. It is more suitable in cases of the rupture of the ligamentum patella?, in trans- verse wounds of the instep, and in cases of talipes equinus, where extension of the tendon Achillis is required; or, after its division,, to properly confine the foot that it may overcome this deformity. TARSO-CRURAL CRAVAT. Description.—I. Two cravats, each one one yard in length. II. A third cravat eighteen inches in length. Application.—So similar to that of the preceding that no wood-cut is necessary; the only difference being that the second one (b, in the preceding figure) is to be applied about the upper portion of the thigh, and to this the long cravat c (of the preceding cut) is to be fastened, after it has been passed through the cravat-stirrup, a, about the foot. Uses.—The mechanism of this bandage is'to forcibly flex the foot, and at the same time the leg, upon the thigh ; and hence is useful in cases of rupture of the soleus or gastroc- nemius muscles, or their common tendon, and in transverse wounds of the back of the heel or leg. Variety.— Tarso-pelvic Cravat. The only difference here being that the cravat is tied about the pelvis instead of about BANDAGES OF THE LOWER EXTREMITY. 117 the upper portion of the thigh. The uses are identical to those of the Tarso-crural. SCAPULO-TIBIAL TRIANGLE AND CRAVAT. (Sling for the Inferior Extremity.) Description.—I. A cravat, or scarf, two yards in length. II. A triangle whose base mea- Fig 102. sures one and one-half yards, and whose height is two feet. Application.—Tie the scarf over the shoulder opposite the injured leg, as a. Place the base of the triangle, near its middle, at the anterior surface of the leg, b, and carry the two ends up- wards and tie into the "sling" formed by the cravat. Then pin the apex of the triangle at the outer side of the leg, to the base of the triangle, as at c ; folding it across the front of the knee, so as to prevent the member slipping too far forwards, and out of its support. Uses. — To support either lower extremity, when injured; or to hold, moderately flexed, the leg upon the thigh. Is a very convenient and useful dressing. Scapulo-tibial Triangle and Cravat. SLING OF THE LOWER EXTREMITY. Description.—A cravat long enough to reach from the neck to the foot, and back again, to tie about it. It is also made from webbing, with a buckle attached, as represented in the cut. 118 MANUAL OF BANDAGING. Fig. 10H. Application.—The limb having been properly bandaged, the cravat or webbing, at its centre, is to be passed underneath the foot, and then tied about the neck. Uses.—As a support, merely, of an injured foot, leg, knee, or thigh, when walking with crutches is allowable. CROSS OF THE GROIN. (Ascending Spica of the Groin.) Description. — This should be made from a roller nine yards in length by two inches in width. Sling of the Lower Extremity. Application.—Place the initial end of the bandage at the Fig. 104 front of the abdomen, 1, and confine by the two hori- zontal circular turns, 2 and 3. Continue in the same course till you come to the ilium of the injured side,. when you descend obliquely across the inguinal region, passing down between the thighs, thus completing the fourth course of the ban- dage. You then encircle the thigh of the same side, and, on coming to its ante- rior surface, ascend ob- liquely across the inguinal region, from without inwards, upon the abdomen, to the opposite side of the body, thus completing the fifth course. Course 6 is made similarly to course 4; course 7, to course 5 ; course 8, to course 6 ; course 9, to course 7 ; Cross of the Groin. BANDAGES OF THE LOWER EXTREMITY. 119 and so on until the roller is nearly exhausted, when you make one or two horizontal turns about the abdomen, and confine. Uses.—For maintaining dressings upon the inguinal region; also for making compression upon any of the enlarged glands in this neighborhood, and for maintaining a replaced hernia. Variety.—Descending Spica of the Groin. This differs from the preceding only in having the courses of the bandage across the groin run from above downwards; that is, course 4 of the bandage is put in the line of course 16 ; course 5, in the line of course 17; course 7, in the line of course 15, and so on. TRAPEZOIDAL T OF THE GROIN. Description.—I. A piece of cloth, cut to the shape of a trapezoid, sufficiently large to cover the groin. II. To one of the angles of the base of this trapezoid, the external superior (as a in the following figure), stitch a small roller, two yards in length by one and three-quarter inches in width. III.—To the other extremity of the base, b, stitch another roller of the same width, but three yards in length. IV. Across the apex of the trapezoid stitch another roller, having the same width, but being two feet in length, as at c. Application.—Place the Fig. 105. base, a-b, of the trapezoid above the injured groin, and encircle the abdomen with the roller a, as a'. Conduct the roller b across the crest of the opposite ilium, then di- agonally downwards across the sacrum and nates to a point considerably below the great trochanter, and then obliquely upwards across the trapezoid, as b', and the ab- Trapezoidal t of the Groin. domen, to pass around the back again, and tie with the portion a at the side. Pin the portion b' to the trapezoidal 120 MANUAL OF BANDAGING. piece of lint, and also to the roller-turn, a'. This done, encircle the thigh with the roller from the inferior portion of the trapezoid, as at c, confining it with a pin. Uses.—For confining cataplasmata and other dressings to the groin and anterior surface of the thigh, when the patient is kept in the recumbent posture. Is of little or no value in exercising compression, and hence does not, in this particular, take the place of the Spica of the Groin just described. CRURO-INGUINAL TRIANGLE. Description.—A triangle one yard in length across its base, and some eighteen inches in height. Application.—Place the base of the triangle a, just above and to the inside of the anterior spine of the ilium, the right for example, in an oblique manner; carry, then, the internal (inferior), extremity about the injured thigh, from within outwards, and pin, as at b. Then conduct the other extremity around the body, bringing it for- wards and . obliquely downwards across the opposite inguinal region, c, and pin to the base of the tri- angle. The apex is then to be car- Cruro-inguinai Triangle. rie(j backwards and downwards across the gluteal region of the injured side, and confined as usual. Uses.—This bandage of Mayor's is very useful in confining dressings to one of the nates, upper part of the thigh, or one of the inguinal regions. Variety.—The Cruro-pelvic Triangle is made, essentially, in the same manner; the only difference being that the base of the triangle is applied farther up upon the abdomen, thus adapting it more especially for confining dressings about the crest of the ilium, and the lower lateral portion of the abdomen. BANDAGES OF THE LOWER EXTREMITY. 121 CRURO-PELVIC CRAVAT. (Inguinal Cravat.) Description.—A wide cravat one yard in length. Fig. 107. Application. — Place the middle of the cravat at the pubic region, as a; carry, then, the superior extremity, or the one to the opposite of the dis- eased side, obliquely up across the opposite inguinal region, over the iliac crest, and around the back; then conduct the other extremity about the thigh of the injured side, as b, Cruro-pelvic Cravat. mounting up across this ingui- nal region, and at last tie with the other extremity at the side, as at c Uses.—For confining dressings upon the supra-pubic, in- guinal, and lower gluteal regions. SACRO-BI-CRURAL CRAVAT. Description.—Two cravats, each four feet in length. Tie them together at one of their extremities. Fm 108 Application.—Place their point of tying at the lumbo- sacral region, bringing both free extremities, A and b, for- wards and downwards across the inguinal regions, one upon each side ; then pass them in between and around the thighs, and conduct them obliquely upwards and across the ilio- pubic regions, a' and b', to con- fine them there with pins. Uses.—For confining dressings upon both groins, as in cases of bilateral buboes. Sacro-bi-crural Cravat. 122 MANUAL OF BANDAGING. DOUBLE T OF THE PERINJSUM. Description.—I. A broad band, long enough to encircle the body. II. Two strips, each one yard in length by two inches in width, sewed at right angles to the broad band, one inch from each other, at its central portion. Application. — Place the centre of the broad band at the lumbo-sacral articulation, and confine it about the body, as at a. Bring forwards, between the thighs, each of the other strips, and pin them to the broad por- tion of the bandage, as at b and c Uses.—To maintain dress- ings upon the sacrum, anus, Double T of the Perinseum. . . perinseum, and vulva. Variety.—Simple T of the Perinmum. This differs from the above only in having a single perinaeal strip. Is used for the same purposes for which the double X is employed. PERINEAL CRAVAT. Description.—I. A broad bandage to encircle the abdo- men, as in figure 109. II. A cravat two feet in length. Application.—Having applied the abdominal band, as in the preceding cut, a, pin (or button) one end of the cravat to the sacral portion of the broad band; pass the other extremity between the thighs, and pin at the pubic portion of the band. Uses.—Similar to the " X Bandages of the Perinaeum." Ladies make use of this cravat for protecting themselves against the menstrual flow. BANDAGES OF THE LOWER EXTREMITY. 123 SACRO-PUBIC TRIANGLE. Description.—This should be a triangle one yard in length, by eighteen inches in height. 110. Application. — Place the base of the triangle, a, at the lumbo-sacral region, with the apex downwards, and carry the two extremities forwards around the body, tying or pin- ning, at the front. Then carry the apex, b, of the triangle for- wards between the thighs, and pin, at the pubes, to the tied extremities. Sacro-pubic Triangle. Uses.—To maintain dress- ings upon the sacral and lower lumbar regions, the perinseum, vulva and anus. FOUR-TAILED BANDAGE OF THE HIP. Description.—A piece of cloth one yard in length, by eight inches in width, torn to a four-tailed bandage; see figure 4, page 22. Application.—Place the plane of the bandage over the dis- eased hip, and carry the two superior ends around the pelvic brim, and confine by tying. Then conduct the two inferior extremities about the upper portion of the thigh, of the side diseased, and fasten as usual. Uses.—To confine cataplasmata and similar dressings, to the parts it covers. COXO-PELVIC TRIANGLE. (Triangular Bonnet of the Nates.) Description.—I. A cravat four feet in length. II. A triangle having a base one yard in length and a height of eighteen inches. 124 MANUAL OF BANDAGING. Application.—Encircle the lower portion of the abdomen FIg. in. with the cravat d, and confine by tying. Then place the middle of the base of the tri- angle, a, below the great tro- chanter, with the apex up- wards; then encircle the thigh with the free extremities of the base, and confine by tying as at b. This done, carry the apex of the triangle upwards, and confine it to the cravat, as Coxo-peivic Triangle. you see in the wood-cut, at c. Uses.—To retain soft dressings to the parts it covers. LUMBO-SCROTAL TRIANGLE. (Suspensory Bandage of the Scrotum.) Description.—I. A cravat sufficiently large to encircle the body. II. A triangle having a base of fourteen inches and a height of ten inches. Application.—Tie the cravat, a-a, about the lumbo-hypo- Fig. 112. gastric regions. Place the base of the triangle close up to the pubes, beneath the scrotum, and carry the ends, b, b, up over the cravat, then down be- neath it, and forwards again, as you see in the cut, and tie in front, as d. Carry the apex of the triangle upwards across the front of the scrotum, passing beneath the tied extremities, and beneath the cravat, and fold down over and in front of the cravat, confining with a pin. Lumbo-scrotal Triangle. BANDAGES OF THE LOWER EXTREMITY. 125 Uses.—As a suspensory bandage for the scrotum, and its contents, and as a retainer of dressings to the parts. BOURSE OF THE SCROTUM. Description.—I. A piece of cloth, folded to a double square, six or eight inches in size. Cut off Fig. 113. the folded corners by the dotted lines, a-b, and c-d, in figure 113. It is then to be stitched across, from a to b, and from c to d. II. Around the upper portion of this, e-d-e', is to be stitched, at its central portion, a roller two inches in width by four feet in'length. III. To each inferior extremity, A and a', there is to be stitched a roller Bourse of the Scrotum. one inch in width by two feet in length. Application.—Place the scrotum in the bourse, and draw the penis through the opening left at d, c. Conduct the broad band around the body, and confine by tying. The other two strips that are attached to the inferior portion of the bandage, are to be carried between the thighs, across the perinseum, and up over the buttocks, one upon each side of the body, and con- fined to the broad band that encircles the abdomen. Uses.—To retain dressings to the scrotum, or to exercise compression upon its contents ; but more especially as a sus- pensory bandage. Rubber makes a good substitute for the linen bourse when compression is demanded, as proposed by Richard and Nelaton, in cases of voluminous varicoceles and sarcoceles. Nelaton employed, in these cases, small tubes caoutchouc vulcanis'e, and by so doing forestalled the American surgeon in a similar use of the capote. Compression can also be maintained by the use of adhesive strips, which method is fully described in the Chapter upon Strappings. 126 MANUAL OF BANDAGING. DOUBLE T OF THE TRUNK. Description.—I. A large, quadrilateral portion of cloth to encircle the abdomen. II Two strips, sufficiently long to pass over the shoulders, to act as "suspenders." III. Two strips of the same length to be passed across the perinseum. Application.—Having encircled the abdomino-lumbar re- Fig. 114. gions with the broad quadrilateral portion of the bandage, pass the two portions, b, b', of the bandage from the posterior to the an- terior surface, and con- fine with pins to the main bandage. Then, pinning the remaining two strips to each lum- bar region of the broad bandage, conduct them forwards, across the pe- rinaeum, and upwards to the abdomen, there to confine; having care to have crossed them upon the perinaeum, so that the strip fastened upon the right of the patient, posteriorly, shall be fastened upon the left, anteriorly, etc. Uses.—As a dressing after paracentesis abdominis, or evis- cerating wounds. Also, as a retainer of pubic and perinaeal dressings. Note.—For the Spiral of the Abdomen, see page 82 ; and for the Circular-Quadrilateral of the Abdomen (and the Abdo- men and Thorax), and the Dorsal Cervico-Sternal Triangle, see page 83. The uses of these bandages are similar to those for which the Double X OI* the Trunk is employed. Double T of the Trunk. CHAPTER XI. IMMOVABLE DRESSINGS. This variety of surgical dressing has long been known to the profession. The Father of Medicine, Hippocrates, was quite conversant with the use of this apparatus, and used it in most cases of fractures. His teachings upon the subject seem to have been lost sight of, however, during the many centuries that have followed him, and so the introduction of this style of dressing, during our later years, has been accredited to the reviver as a new discovery. Resurgam is the epitaph of all things surgical, and the history of the succeeding ages is but the unfolding of the truthfulness of the prophecy. In other words, a modern inventor (so-called) can hardly hope to be anything further than a reviver of some forgotten principle. The stiffening substance made use of by Hippocrates, was wax, rosin, and cerate, instead of the plaster-of-Paris, starch, dextrine, etc., made use of by the moderns. This was well rubbed into the bandage, and upon each succeeding turn of the applied roller, besides being applied to the compresses, packings, and even the limb itself. Mr. Eaton, the English Consul at Bassora, introduced the knowledge of these hard plaster bandages to the English public in 1798, and Pirogoff, in 1854, during the Crimean war, used it very extensively. THE BAVARIAN PLASTER SPLINT. Description.—Take two pieces of Canton flannel, of length sufficient for the injured member, and of width sufficient to overlap slightly when brought around the limb. Those for the leg would resemble the pieces of the leg of a stocking when it is cut vertically. The pieces should now be fl271 128 MANUAL OF BANDAGING. Fig. 115. The Bavarian Plaster Splint. stitched together at the back, one to the other, down the median line. Application.—Spread the bandage out under the limb, so that the stitched portion will correspond to the back of it; carry, now, the upper piece about the limb, and fasten by stiches or pins, as you see in the wood-cut, Fig. 115, a, a, a. The mem- ber now being firmly held, an assistant mixes the plaster - of - Paris with about an equal bulk of water. This is then poured over the limb, when it is en- wrapped with its covering, A, A, a, and evenly distributed over its surface. The edges b, b, b, b, of the other piece of flannel are then caught up and brought forwards around the limb, and confined by a suitable roller, or by straps. The plaster soon hardens, and then the edges of the bandage may be trimmed, the portion pinned or sewed can be unfastened, and you have then an excellent splint for a member. The stitching at the back plays the office of a hinge, thus facilitating its removal and application. Caution.—In this, and all other hard dressings intended to remain some time upon the limb, you must guard all uneven- nesses of the member, as the region of joints, etc., with abun- dant layers of cotton-wool, as the bandage is apt to contract slightly after its application, thus engendering gangrene. Gen- erally it is best to wait three or four days after simple frac- tures, as of fibula or tibia, with no displacements, before the strictly immovable dressing is applied. In other cases ten or twelve days is the usual time recommended by authorities. Uses.—As a support to a dislocated member, fractured bones, or separated cartilages ; also in inflammation of joints when " absolute rest" is to be sought. IMMOVABLE DRESSINGS 129 If there should be any undue swelling of the limb, or over- much pain be caused by the pressure of the bandage, of course it should be at once removed. The following rules, from Hip- pocrates, are clear and decisive, and form an excellent guide for the surgeon in bandaging, either with the movable or im- movable apparatus. Quoting from Jlepl 'Ayptiv § 5: "These are the signs if the patient has been properly bandaged: if you ask him if the limb feels tight, he says it does, but moderately so, especially about the seat of fracture. And these are the symptoms of a moderately tight bandage: for the first day and night the patient fancies the tightness does not diminish, but rather increases ; on the next day there is a soft swelling [oedematous] in the hand, or foot, for this is a sign of moderate compres- sion; but at the end of the second day the compression should feel less, and by the third day the bandage should seem loose. If any of these symptoms be wanting, you may conclude that the bandage is slacker than it should be; or, if any of them be in excess, you may infer the compression is more than moderate [i. e. hurtful]." THE COMMON PLASTER DRESSING. (Pirogoff's Plaster Bandage.) Description and Application.— Having first well padded the limb with cotton-wool, envelop it with a flannel roller, neatly, evenly, and somewhat tightly. Then make your plaster ready, by getting it to the consistency of cream, by adding to it about an equal bulk of water (mixing up but one-half a tea- cup of it at a time); into this mixture dip the pieces of muslin (thin) that you have prepared, in suitable strips and squares,, and begin laying them evenly around the limb. As soon as the plaster-mixture begins to harden in the dish, throw it out and mix up a new batch, continuing the application of the muslin strips, as before. You will find strips two to four inches in width, and long enough to go one and one-half times about the member, the most convenient size for applying, ex- 130 MANUAL OF BANDAGING. cept in the region of joints ; here squares, or oblong squares, are very serviceable. When you have the whole to the requi- site thickness to furnish efficient support to the member, encase the whole dressing with a layer of the gypsum, by pouring a portion upon the limb enveloped with plaster-cloths, along its entire length. The same cautions should be observed here as in the preced- ing variety, remembering this is a permanent dressing. The limb should be kept immovable during the application, and very quiet for some time afterwards, so that the plaster may not be cracked whilst hardening. After this, if the condition of the patient permits, the member can be swung in a " sling," and the patient permitted to walk or ride out, with little or no dan- ger. Uses.—These are similar to those just enumerated under the Bavarian bandage. It might be well to notice that the hardening of the plaster can be delayed by the addition of a little stale beer, or size, to the mixture ; or it can be accelerated by the addition of sodic chloride (common salt), alum or by using warm water to " wet it up." It is best to paint the whole, after it is dry, with an application of glue, varnish or albumen, so as to prevent " chipping" of the exterior. This bandage is also made of of starch. STARCH, OR PLASTER ROLLER. Description.—Having a bandage (of the required length and width) of some meshy or loosely woven material, as cheese cloth, fill the meshes of it with the powdered gypsum, or starch, by rubbing it in, and then roll up firmly and evenly. A little machine has been invented for the purpose of facilita- ting the manufacture of this very useful form of dressing. This is shown in Fig. 116. It consists of a narrow box, with an opening in the end at a, through which the cloth is in- troduced, after the ravellings are carefully removed from the sides ; it then passes over a roller, so as to ensure an even dis- IMMOVABLE DRESSINGS. 131 Fig. 116. tribution of the plaster overlying it, and out at the opposite end of the box to be wound upon the roller, b. A cover fits over the box when in use, and when not in use the outside roller and the crank can be detached, and the crank arms shoved back on the box, so as to make an easily portable apparatus. The plaster, in all these bandages, should be fresh, and finely ground; otherwise there will be difficulty in their properly hardening. They can be rolled up in quantities, if you de- sire, if you will keep them excluded from the air, in a tight tin pail, and covered over with loose plaster-of-Paris. In this form, the plaster rollers may be made five or more inches in width, and then cut to the desired width when wanted for use. Application.—When you are ready for applying the rollers above described, dip them into a pail of warm alum water ; the alum increases the quick-setting, or hardening, of the plaster- of-Paris. There should be about an ounce of alum to the pint of warm water. The bandages should soak a while in this, then the water should be thoroughly squeezed out from the roll, when it is ready for application to the limb of the patient. Have the limb protected with a thin layer of cotton-wool, then apply the wetted bandage quickly, though smoothly and evenly about the member, just as you would a common "spiral," or reversed bandage, to the same member. It quickly hardens, and you have then quite a firm casing for your patient's limb. It is not quite so secure or firm as the Starch or Plaster Dres- sing just described, yet is very useful, as it is so much lighter. Varieties.—The roller may be prepared as above, and on each succeeding turn of it about the member, it may be freely 132 MANUAL OF BANDAGING. brushed over with the plaster-cream, starch, gluten, silicate of potash, glue, or whatever hardening substance is used, as in the method employed by Hippocrates when using his compound of rosin, wax, and cerate ; at last, brush the whole over with a thin layer of the substance made use of. In all of these " hard" bandages, it is well, a day or two after their application, to give the whole a coating of varnish, gluten, or gum, in order to prevent the bandage "chipping." This form of plaster dressing was introduced in 1854 by the Dutch surgeon Maythysen. The Banddge of Scultet has also been made use of to make the " immovable dressings ;" but it is not secure enough to come into general use. It is the parallel strips seen at b, Fig. 99, and is to be similarly applied. The Silica Bandage is now considerably used. It dries more readily than the gypsum, and possesses the advantage of being soluble in water, hence quite easily removed. The Paraffin Bandage of Mr. Tait is recommended for open wounds, as it does not absorb the secretions as do the other varieties of dressings. The substance is kept melted by having its container in hot water. The roller is to be passed through it as it is applied. FENESTRATED IMMOVABLE DRESSINGS. Description.—Any of the preceding varieties of immovable bandages may have openings left in them through which the secretions may find ready exit. It would be well to coat the margins of the fenestrse, for some distance around them, with paraffin, so as to prevent the ab- sorption of the fluids by the dressing. If the paraffin should happen to crack, it can be easily mended by passing a hot spatula over it. Dr. Pennington suggests, as a method for preventing the discharges from passing between the skin and the hard dress- ing, the application of a piece of oil-silk beneath the wound, causing it to adhere to the skin by the free use of ordinary IMMOVABLE DRESSINGS. 133 collodion. The oil-silk is then drawn out over the edges of the f enestrse, and so furnishes an easy egress for the fluids from the wound, at the same time protecting the bandage. The oil-silk is secured by first brushing over the skin the ordinary collodion, and then applying the oil-silk, and finished by applying another coat of collodion on the surface of the oil-silk. Uses.—These are applied in cases of compound fractures, open or suppurating joint-troubles, where a discharging sur- face would otherwise be covered in by the dressing. REMOVING "IMMOVABLE" DRESSINGS. For assisting in the removal of these various hard dressings, shears, saws and knives, of sundry patterns, have been devised. Probably as handy a tool as any is The Shears-saio, designed by Dr. Watson, of Jersey City, and which is shown in Fig. 117. It consists of Henry's shears slightly modified, i. e.,made much lighter, less curved, and blades of equal length, with a convex saw-blade attached to the upper blade. As most of the sawing is done on the pull, the teeth are pointed backward. In using Fig. 117. Watson's Shears-Saw. this instrument for removing plaster bandages, you make two parallel incisions with the saw about one-third of an inch apart, on any convenient aspect of the dressing, through the ^aster to the muslin from end to end of the plaster. The strip of plaster between these incisions is easily removed by using the lower blade of the shears as an elevator, after which the muslin is readily cut through with the shears. Nitric Acid.—Dr. F. H. Murdock, of Bradford, Pa., says a very convenient way to remove a plaster-of-Paris bandage is as follows: Take a strong solution of nitric acid, and by means of a camel's hair pencil paint a strip across the bandage at the 134 MANUAL OF BANDAGING. most desirable point for division. The acid will so soften the plaster that it may be readily divided by means of an ordinary jack-knife. TREATING COMPOUND FRACTURES.* Plaster-of-Paris is a valuable adjuvant in the treatment of compound fractures. The plaster cast, with fenestrated open- ings opposite the site of the wound, is a decided improvement over the movable splint; yet this has its disadvantages, owing to the fact that the discharges from the open wound soften the plaster and weaken its support, necessitating its re-application before the union of the bone takes place. This may be ob- viated by using paraffin or oil-silk, as just de- scribed, or by the device shown in Fig. 118. The application of the plaster-roller is similar Compound Fracture of the Leg. to that already de- scribed, remembering that the parts to be covered with plaster should first be covered with one or more thicknesses of cotton batting, to allow for any swelling that may occur. The first step to be taken before the application of the plas- ter, should be a thorough examination of the conditions of the fracture (the patient being, of course, under the influence of an anaesthetic). We are now ready for the application of the plaster-bandage. It should, in case of injury of the lower ex- tremity, extend well up above the knee, also on the foot, leav- ing that part where the wound exists perfectly free, as in Fig. 118. As soon as the plaster is solid, which will be almost imme- * This is altered and condensed from a pamphlet by Professor H. O. Walker, M. D.» of Detroit, upon the subject of Plaster Dressings. IMMOVABLE DRESSINGS. 135 diately, you can, by the aid of your pjG# U9. assistant, make proper extension and counter extension, with the splints, a and b, Fig. 119, which can be adjusted and fastened with a few turns of a narrow, viy*'^f?i -Q« wet plaster-bandage. The splints, you ^ e observe, consist of properly shaped iron bars of sufficient strength to support the weight of the leg, and not permit of bending. To each end is fastened a properly shaped piece of perforated tin, or zinc. Any blacksmith can make these splints from a model that you can make yourself by taking strips of tin and bending them to the shape to which you wish to apply them. You must allow for sufficient space between the iron bars and the leg to apply an antiseptic dressing. Fig. 118 gives a representation of the manner of suspension consisting of a light-made saw-horse; or, what may be much better, a piece of board of proper length, one inch in thickness and two in width, into which is fastened, at either end, a screw- hook and suspended to the ceiling. On its under surface three or more hooks should be screwed for the fastening of small chains, and these again fastened equably to fine wire hooks, which have been incorporated in the plaster. You will observe in the cut that rubber tubing has been used for the suspension; this adds very materially to the comfort of the patient. This apparatus makes an immovable dressing, which can remain on until the case is cured, giving comfort to the patient, allowing him to be moved from the bed to the chair if desired, and certainly reduces the labor of the surgeon to a minimum. If you desire to increase or decrease the amount of extension, this can be done by incorporating in the bars, above and below the joint, the extension screw c, Fig. 119. In the Treatment of Hip-joint Disease, plaster-of-Paris proves of value, especially in the first stage where absolute rest is desirable, and is best applied while the patient is sus- pended by a Sayre's apparatus (see page 137), the well foot standing on a chair, and the other supported or extended by an assistant. The plaster extends from the ankle to the umbilicus, 136 MANUAL OF BANDAGING. and is made firm at the trochanter by interlacing perforated tin strips; or, what is still better, thin strips of hickory or any elastic wood, well soaked for a few hours before using. Where exposure or extension of the joint is necessary, the apparatus depicted in Fig. 120, which consists of curved bars of Fig. 120. iron attached above and below to proper sized (jfe-r-rr^S pieces of perforated tin, should be applied over the Nifflk ', Jjjj joint, and the whole held in place by a few turns m \ of a wet plaster-bandage. JJL_ ^ J Where motion, as well as extension, is desired, ^HL,"' ]iW ^e applicati°n °f Stillman's " Sector Splint " vn^ serves a good purpose (see Figs. 121 and 122). It admits of the patient's walking about, and also allows: 1. Extension at any angle with motion. 2. Extension at any Fig. 121. Fig. 122. Stillman's Section Splint. angle with fixation. 3. Fixation at any angle. 4. Motion, complete or limited, constant or occasional. 5. Exposure of surface about joint, admitting compression, elastic or other- wise, hot and cold applications, blisters, dressing and easy in- spection. 6. Motion, extension, and elastic tension by the addition of appropriate rubber cords. IMMOVABLE DRESSINGS. 137 These "Sector Splints" may be applied to either the hip or knee, and devices of a similar character are applicable for the treatment of a majority of joint troubles having for their basis of attachment plaster-of-Paris. SAYRE'S PLASTER BANDAGE FOR THE SPINE. To Professor Lewis A. Sayre, M. D., of New York City, the medical profession is under more obligations than to any other man for the introduction of the use of plaster-of-Paris as a curative dressing for spinal and joint troubles. His method of application of the " Plaster-of-Paris Jacket" for spinal troubles is given herewith as condensed from the Trans- actions of the American Medical Association. Description.—The patient is to be suspended by means of an apparatus, prepared for the purpose (see Fig. 123), consisting of a curved iron bar with hooks at either end, from which pass straps that are attached to pads that go through the axillae, and also under the occiput and chin, and are capable of being made shorter or longer, ac- cording to the length of the patient's neck. The iron bar is suspended from the ceiling by means of a compound pulley, through which grad- ual extension can be made until the patient is drawn up so that the feet swing clear from the floor. Previous to the suspen- sion, however, a thin flexible leaden strip should be laid upon the spinous processes for the entire length of the spinal 138 MANUAL OF BANDAGING. column, and bent into all the sinuosities, so that it may take a perfect outline of the deformity. This strip is then laid upon paper and its outline marked with ink, and we have a perfect mathematical outline of the irregularities along the spinal column. After the patient has been suspended, the same leaden strip should again be applied along the spinous pro- cesses, as in the first instance, and another pattern, made upon paper, by the side of the first. We thus have a means by which comparison can be made, and so are able to determine exactly what changes have taken place in the curve. The shirt, which should be woven, or knit, without seams, and tightly fitting the body, is next pulled down, and an open- ing made in front and rear, through which a ribbon or piece uf bandage is passed, for the purpose of holding in place a handkerchief placed in the perinseum, and at the same time making the shirt fit the hips exactly; for the tighter the shirt fits, the less number of wrinkles there will be in it. Fig. 124. Fig. 125. " Jury Mast." " Jury Mast" applied, lateral view. IMMOVABLE DRESSINGS. 139 Application.—With the roller bandages, previously pre- pared (see page 130) commence by applying one just around the smallest part of the body, going to the crest of the ilium, and a little below it, and lay it around the body smoothly, but do not draw upon it at all, having previously placed quite a thick layer of cotton-batting over the stomach, withdrawing the bat- ting on the hardening of the whole. When applying, unroll the bandage with one hand, while the other follows and brings it into smooth, close contact with all the irregularities of the surface, over the ilium, and dipping into the groin, then over the abdomen again and dipping into the groin again, and so on, from below upwards, in a spiral direction, until the entire trunk has been inclosed from the pelvis to the axilla?. After one or two thicknesses of bandage have been laid around the body, in the manner described, narrow strips of perforated tin are to be placed, parallel with each other, upon either side of the spine, from two to three inches apart, and in numbers suf- ficient to surround the body, and another plaster roller carried around the body, covering them in the manner in which the first bandage was applied. These few strips strengthen the bandage, and obviate the necessity of increasing its weight by the application of a large amount of plaster. If there are any very prominent spinous processes, which at the same time may have become inflamed, in consequence of pressure produced by instruments previously worn, or from lying in bed, it is well to guard such places by means of little pads of cotton, or cloth, or little glove fingers filled with wool, which is elastic, which are to be placed upon either side of them before applying the bandage. Another suggestion, which I have found to be of practical value, is to take two or three thicknesses of roller bandage, three or four inches long, and place them over the anterior superior spinous process of each ilium. These little pads are to be removed just before the plaster has completely set, con- sequently leaving the bony part free from pressure after the soft parts have shrunken under the influence of the continued pres- sure produced by the plaster-dressing. It is also well, just 140 MANUAL OF BANDAGING. before the plaster has set completely, to place one hand in front of the ilium and the other over the buttocks, and squeeze the cast together, so as to increase this space over the bony prom- inences. In a very short time the plaster becomes sufficiently " set, " so that the patient can be removed from the suspending apparatus and laid upon his face, or back, on an air-bed, there remaining until the hardening process is complete. A hair mattress answers a very good purpose, but the air-bed is prefer- able, especially if there is much projection of the spinous processes, or of the sternum. If, however, the plaster-rollers have been dipped in warm alum-water before applying, the cast will be usually solid enough, by the time you are done, to admit of the patient's walking about. "JURY MAST." Description.—In case of disease of the cervical and upper dorsal vertebrse, Dr. Sayre uses the head-suspension (shown in Figs. 124 and 125), or "Jury Mast." This consists of a steel rod, secured to two pieces of malleable steel which are placed on either side of the spine, and which can be bent so as to accu- rately fit any curve in the plaster-jacket that has already been applied to the entire trunk of the diseased patient, and retained accurately in position by having attached to them three narrow strips of perforated tin, which should be long enough to very nearly encircle the entire trunk, leaving only a central line of an inch or so in width, in front of the body, for the pur- pose of cutting or sawing down the plaster-jacket whenever it may become necessary to remove it. The central bar is attached, by two cross-bars, to the upper portion of this malle- able framework, and is curved over the top of the head to the vertex; and to its extremity is attached a swivel bar, three to five inches in length, from which the head is suspended by ad- justable straps secured under the chin and occiput. This upright bar is made in two pieces running into each other at the straight portion behind the neck, and capable of being extended to any desired length, and firmly secured in position by screws. IMMO VABLE DRESSINGS. 141 Application.—To apply the apparatus, the patient is sus- pended in the usual way, from the axillse, chin, and occiput, and the plaster-bandage applied, as usual, over a tight-fitting knit or woven shirt. After the bandage has been accurately applied, and the plaster has hardened, or " set," the patient can be permitted to stand up, when the apparatus for suspend- ing the head is to be applied in its proper position, over the back of the plaster-jacket, and the lower portion of it bent and moulded until it accurately fits all its various curves. The loose tin strips, being very flexible, can then be smoothly moulded around the jacket, which has already been.applied to the trunk, and another plaster-bandage, having been wetted in alum-water, is to be carefully and tightly applied over the apparatus, and the jacket first applied, in sufficient number of layers to make it perfectly secure. The tin being rough and perforated, a sufficient amount of plaster will be incorporated into its holes and meshes to prevent any possibility of displace- ment. This makes a secure point of support from the pelvis and trunk from which the head can be sustained by properly adjusting the movable rod and securing it by screws. Its practical application is seen in Fig. 125, and the ease and comfort to the patient, together with the perfect freedom of mobility to the head, make it a very satisfactory apparatus, Variety.—Professor H. O. Walker, of Detroit, has made a modification of this " Jury Mast," that is detailed in the fol- lowing description, condensed from an article in Leonard's Illustrated Medical Journal. In the first place he directs the hair to be cropped short, and then applies a "Plaster Jacket." The plaster jacket in itself is of no benefit whatever save as it serves the purpose of a foundation for the superstructure to be built upon. After allowing the jacket to dry for a few minutes, the patient is seated on a stool, and the head suspended to a hook in the ceiling by a four-tailed bandage, somewhat after the manner of a Barton's fracture bandage for fractured jaw; that is, by first placing a bandage under the jaw, and allowing it to meet several inches above the head, and another in front 142 MANUAL OF BANDAGING. Fig. 126. of the jaw, passing back to the occiput, where it is pinned or sewed, then pas- sing the ends of the bandage up to meet those from the front and then up to the hook, using just enough of ex- tension to keep the body erect and patient perfectly comfortable. The surgeon then winds around the neck and head one thickness of glazed sheet wadding, for protection against any irregularities in the plaster-bandage. (The bandages should be narrow, about one-and-a-half inches in width, as it is necessary to reverse quite frequently in this application). After applying two or three thick- nesses, he interlaces perforated zinc strips, half inch in width, extending around the head, down the back and in front, so that a firm support for side view. the head is well attached to the jacket below. The only parts exposed are the top of the head and that portion of the face which you see exposed in Fig. 126. THE "SILICA JACKET." The Silica Jacket, as first proposed by Wolff, of Berlin, can be applied in a similar way to the plaster-of-Paris. Some pre- fer the silica for the jacket, as the silica is readily soluble in water, and chipping is more easily controlled. Fig. 127. After it has become thoroughly hardened, it may be divided over the sternum, as shown in Fig. 127. It is then removed with the shears-saw (Fig. 117), a row of eyelets punched down each divided border, the shell re-lined with cotton-wool, and then the whole re-ap- plied to the patient's body, and laced up. smca Jacket." A layer of cloth wet with the silica should IMMOVABLE DRESSINGS. 143 be applied over the roughened edges of the jacket where it has been cut apart, so as to render the whole as smooth as possible. This should also be done in all cases of the plaster casts of the limbs whenever they are cut apart, and preserved for a re- application. Manila Paper Splints.—Dr. R. O. Cowling has suggested taking common manila paper, soaking it well in starch, then carefully moulding it to the parts when it is wet, as a substi- tute for the starch, plaster, or silica roller. It makes a more serviceable dressing, oftentimes, than pasteboard alone, or even the patent felt splint. It is well to finish up all these various hard dressings with egg albumen, or varnish, so as to reduce the chances of chip- ping or crumbling to a minimum. CHAPTER XII. UPON STRAPPINGS. In strapping a limb we seek one or more of the following purposes : I. A " support" to the divided tissues. II. A compression of the part, so as to favor absorption of effused materials; or, to prevent too exuberant granulation, or hernise. III. To gain a fixed point upon the member, so as to be enabled to maintain extension of the same. For one, or of all of these purposes, the common adhesive plaster of the shops (Eplastrum Resinm) is employed. The formula for its preparation, according to the American Phar- macopoeia, is : B. Resinae pulveris, J vi; Emplastri Plumbi, 5xxxv. This often proves irritating to the skin, from the amount of rosin it contains, if the plaster is to belong applied. The irri- tability of the plaster may be lessened by using less rosin in its making. Baynton, to whom the profession is indebted for the intro- duction of the " strapping treatment " of old ulcers, made use of a formula containing but six drachms of the rosin to a pound of the lead plaster, less than one-half the amount used in the officinal formula. The Dublin College, and also the British Pharmacopoeia, incorporate a small amount of soap in their adhesive plaster, thus engendering a greater pliability of the dressing. The plaster is spread upon heavy muslin, or Canton flannel, by the aid of machinery, and comes to us in rolls of several yards in length. The strips we use should always be cut [144] UPON STRAPPINGS. 145 lengthwise from the roll, otherwise the cloth will "give," when extension is made upon it, thus loosening the plaster from its 11 hold " upon the member. Generally narrow strips are employed in supporting wounded parts, but those from one to two inches in width when compres- sion or extension is desired. After the strips have been cut, they should be heated, by placing the back of the plaster to a tin vessel containing hot water, or to the stove-pipe, before applying to the limb. They will "take hold" much better by so doing. If the part to which they are to be applied is hairy, a " clean shave " will be necessary before you can make a satisfactory application, and will save much trouble and pain when you come to remove them. In removing adhesive strips from a wound that is uniting, care should be exercised lest you pull the lips of the wound asunder. If you support the wound with your finger, and remove each end of the strip up to, and not crossing over, the uniting .line of the divided structures, you will reduce this danger to a minimum. The portion of the plaster adhering to the limb, after the strips have been removed, is best cleaned off by first rubbing with olive oil, vinegar, or turpentine, and then washing away with soap. The surgeon's fingers are readily cleansed in the same way. Oftentimes you will find the plaster discolored when applied to a suppurating member. This is owing to a decomposition of the lead in the plaster, due to the action of the secretions upon it. STRAPPING FOR THE FOOT AND ANKLE. Application. — Having cut your strips one or one and one-half inches in width, and of sufficient length to cross over the end first applied, as you see in the figure, you place the centre of the strip over the back of the heel, and bring one end, 1, down firmly, and somewhat forcibly, to the 5th meta- 146 MANUAL OF BANDAGING. tarso-phalangeal articulation. Then seize the opposite end of the strip, and bring it equally firmly down over the tarsus, 2, to the 1st metatarso-phalangeal articulation. The other strips, 3, 5, and so on, are applied in a similar figure-of-8 manner, having care to overlap each preceding one a portion of its width. You will find you can exercise almost any amount of pressure by adhesive strips so laid, and care should be used lest For the Foot and . , . . . , Ankle. you interfere too much with your patient s comfort, and so have to take them off before their therapeutical effect may be accomplished. Variety.—Any portion of the body, when compression is desired, is wrapped in a similar figure-of-8 style, ulcerated sur- faces being included in the strappings. It is really surprising the way some chronic (especially varicose) ulcers will improve after a week's treatment of good and vigorous strapping, although at the time of their application they may be some- what painful to the patient. FOR WOUNDS. Application. — Having your strips cut of the requisite Fig. 129. Fig. 130. For Superficial Cuts. For Deep Cuts. Fig. 128. UPON STRAPPINGS. 147 length (if the wound be not deep they need not surround the limb, but if the cut be to the bone, large enough to a little more than encircle the limb), you begin at the bottom of the wound (1, in figures 129 and 130) to apply them, the lips being held approximated by an assistant. The first strip having been applied, you follow in the same manner with the remaining ones, having care not to overlay either angle of the wound, or to apply them so closely that pus will not have a free escape. Some surgeons prefer to suture the lips of the wound, and then apply the plaster-strips between the sutures. But if the form of strapping represented in Fig. 130 be used, sutures will be rarely needed. Another, and perhaps better, way for drawing together the lips of a wound, is shown in Fig. 131. This method has the advan- tage of doing away with sutures, and will hold the lips of the wound firmer than will narrow strips of adhesive plaster. It is made from the perforated ad- hesive plaster, and was first sug- gested by Dr. Packard, of Phila- delphia. It leaves the lips of the wound fully open to inspec- tion, and in no manner interferes With getting union by " first in- For Deep or Superficial Cuts. tention;" hence, on this account, it is to be commended. In deep wounds, such as of the thigh, however, it would be best to have the plaster nearly surround the limb, in order that compression could be exerted upon the severed muscular struc- tures as deeply down as possible. FOR THE TESTICLE. Application.—Having the parts shaven, have your patient stand against the edge of a table, or with his back to the wall, 148 MANUAL OF BANDAGING. Fig. 132. keeping the legs separated. You then seize the diseased testis with your left hand, separating it from its fellow, and press it as far as possible into the scrotal sac, thus making its coverings as tense as may be. A short roller, having a width of one-half or three-quarters of an inch, wound three or four times about the up- per portion of the scrotum, encroaching somewhat upon the epididymis, as 1 in For the Testicle. the wood-cut, thus confining the testis. This roller is then fastened by a short piece of the adhesive plaster. You then pass the strips 2 and 3 (which are one-half or three-quarters of an inch in width, and long enough to go perpendicularly around the gland), completely around the testis, beginning them at, and upon, the previously applied roller, and ending them there. This should be continued until the whole organ has been thus enwrapped. Then, taking long pieces of strapping, one-half an inch in width, encircle the gland spirally from the bottom, 4, 5, to the top, overlapping each preceding turn, finishing them over the roller that was first applied. Uses.—In chronic enlargements of the testis, or in some cases of hydrocele. After a day or two's application the organ will be found-to have shrunken; then the dressing is to be re- moved, and re-applied. Variety.—See page 125, upon the tubes caoutchouc vul- canise of Nelaton. The capote is also made a legitimate use of in these cases. In both instances the roller, 1, is to be ap- plied before the rest of the dressing. The ring of the capote should rest upon the applied roller. FOR THE BREAST. Description.—The strips having been cut to a width of one and one-half or two inches, and a length of some thirty inches, they are ready for UPON STRAPPINGS. 149 Application.—The Mamma being supported by an assistant you fasten one end of the strip over the spine of the scapula of the diseased side, and bring it down under the same axilla, and then pass it diagonally upwards across the chest, encroach- ing upon the gland, to and over the opposite shoulder, there ending; you thus follow course 13 of the Cross of One Mamma figured upon page 88. The other strips should be applied in a similar manner, only encroaching upon the gland more and more, until the necessary support has been given. If compression is desired, cross strips can be run diagonally downwards across the chest, from over the shoulder of the diseased side to the hepatic region. An American surgeon has taken advantage of the expansi- bility of sponge in maintaining compression of the mamma. The sponge (a large one) is thoroughly cleansed and impreg- nated with some antiseptic, and then pressed between two flat surfaces until it becomes dry, and as flat as possible. It is then firmly strapped or bound upon the breast with some one of the breast bandages which have been described, and is gradually made to expand by moistening with water, if the secretions from the gland or sore be not sufficient for this purpose. (See pages 88-89.) Uses.—As a support of an inflamed or hypertrophied breast. Also, when compression is used, as a therapeutic agent in the treatment of any of the various forms of abscess that may arise within or about the gland. FOR EXTENSION OF THE LEG. Fig. 133. Extension of the Leg. 150 MANUAL OF BANDAGING. Description.—I. Two broad and somewhat tapering per- forated adhesive plaster strips (Grosvenor & Richards), of a length sufficient to reach from above the knee-pan to below the foot, and tie. II. Several narrow strips of the same material to surround the limb when the strips are applied. Application.—The broad strip, a-b, is applied to the side of the leg, while its fellow is made to do similar service upon the other side of the member. The narrow adhesive strip, c, is then applied about the leg as a confiner. The inferior ends, b, of the two side strips are then tied together, and a wedge of wood, a little longer than the foot is wide, is placed within the noose, to which the weight is attached. The wood is used to prevent the chafing and constriction of the foot, which would otherwise occur from the bringing together of the two inferior ends of the extending strips, as soon as the weight was at- tached. Uses.—In cases of fracture where extension is demanded. Also in chronic arthritis, and for overcoming vicious contrac- tions of muscles or tendons. Variety.—This dressing may be applied to the upper ex- tremity, though an occasion rarely calls for its use there. Note.—Be sure to have the extension strips of sufficient length to reach above the knee-joint, otherwise you will be apt to stretch the joint-ligaments if your extension is long continued. A NEW EXTENSION APPARATUS. Some French surgeon, whose name we have just now forgot- ten, has ordered the following apparatus for making extension upon the foot. It is a rubber bag, shaped as you see in the cut, that surrounds the leg at the astragalo-tibial articulation, with wires in the two ends for fastening the extension-cord. At the back part is a stop-cock and tube for inflating the bag with hot or cold water, or air, as the case may be. We should think this an excellent apparatus for maintaining UPON STRAPPINGS. 151 extension in hip-joint Fig. 134. cases, the counter exten- sion being made on a somewhat similar plan, that of a narrow rub- ber-bag (rather than tube), which could have a stop-cock attached ad- mitting fluids, or air, and this passed over perinseum and groin, and the ends ringed so as to be easily attached to the extending cord running to the head of the bed ^or Extension of Leg or Arm. The advantage in the rubber being that it does not make a "dead" traction; but by its extension and self-con traction it simulates the resiliency of animal tissue. Another feature is that hot or cold water could be used, thus stimulating the ca- pillary circulation, if used alternately; and in other ways it might be beneficial, especially about the ankle joint, in case continuous cold or hot applications might be deemed useful. The water, or air, would tend to equalize pressure, and so pre- vent any undue pressure upon the resisting points of the ankle and foot. STRAPPING FOR VARICOSE ULCERS. Having taken sufficient of the porous adhesive bandage, mentioned several times before in this work, to enable you to properly envelop the affected member, it is to be applied with quite firm pressure about the limb, as shown in Fig. 135. The turns of the bandage about the member are to be made as if you were applying the ordinary " roller " bandage. 152 MANUAL OF BANDAGING. Fig. 135 Strapping for Varicose Ulcers. This porous adhe- sive bandage is spe- cially applicable, in these cases, as it fur- nishes a means of firm support to the dilated veins, at the same time it is easily and evenly applied. Then, too, the porosity of the bandage allows for a certain amount of transpiration from the skin beneath, and also for the discharge from the ulcer itself. ADHESIVE BANDAGES FOR RETAINING SPLINTS. Fig. 136. For Retaining Splints to Members. Another useful applica- tion of the adhesive plaster, cut into proper widths, or for the perfo- rated adhesive bandage, before spoken of, is in re- taining the various forms of splints, and other stiff dressings, to a member. Fig. 136 represents the " bandage " so applied to an " arm splint " where there has been a fracture, or dislocation. The perforated bandage is to be preferred to the plaster strips, as it is non-adhesive to the integument, yet adheres firmly to itself. Then, too, the pores allow of proper transpiration from the skin. UPON PLASTERS. 153 GENERAL DIRECTIONS FOR MEDICATED PLASTERS. Before applying a medicated plaster, the part, if covered by long hair, should be closely clipped, and made thoroughly clean and dry. After removing the face-cloth (which may be readily done by moistening it, if it sticks strongly to the adhesive surface, and, afterwards made dry), the plaster should be well smoothed on, so as to conform accurately to any inequalities, observing that there is no air confined underneath. The back-cloth on cut plasters is designed to protect the patient's underwear, therefore should not be removed. To Remove a Plaster.—This is best done by taking it from off the part quickly, rather than by dragging at it slowly, or pulling it off piecemeal. A plaster should never be worn longer than to obtain the desired result. The different plasters may be kept to best advantage as fol- lows: India rubber plasters should be kept cool. Isinglass plasters must be kept in an ordinary temperature, as moisture and extreme heat soon spoils them. Kid plasters and emp. adhaesivum keep well in moderate temperature free from extreme changes. Mustard and spice must be kept dry, as dampness soon spoils them. CHAPTER XIII. KNOTS. Ligatures were introduced to the profession by Ambroise Pare. Previous to his time the "actual cautery," or the cautery of boiling oil, was made use of for arresting haemor- rhage. Ligatures are confined by knotting their extremities closely down upon the divided vessel they surround. Various styles of knots are employed, though we shall limit ourselves to a description of but three. THE SURGEON'S KNOT. Description.—This is formed bypassing one extremity twice about the other, in making the noose ; and hence makes a more bulky knot. Sometimes the first knot of a ligature is the com- mon single knot, and then the surgeon's knot is made, thus securing it. The objection to this knot is its bulkiness, though it is in quite common use with some operators. THE REEF KNOT. Description.—This is the ligature knot in general use among surgeons for arresting hsemorrhage. A " Granny " knot, b, is quite frequently made for the Reef, a, through in attend ve- ness of the surgeon; and stu- dents almost invariably make it on their first trial of the Reef. It is not a really bad knot; yet it lacks the firmness and surety of the Reef. The The Reef and » Granny " Knots. Reef knQ^ ^ ig made by firgt T154] KNOTS. 155 crossing the ends of the ligature so that the one held by the right hand shall be uppermost. You then pass the right ex- tremity around that held in the left hand, from within outwards; this makes the first knot, which is pressed firmly down to, and drawn constrictingly around, the vessel, by the finger tips. You then cross the ends again, so that the extremity that was held by the right hand, when making the first knot, shall still be uppermost, although consigned to the keeping of the left hand. The second knot is then made by passing the end now held by the right hand (formerly held by the left) around the other extremity, from without inwards, then drawing it closely down to its fellow by the finger tips again, thus completing the knot as a whole. The secret in avoiding the Granny knot, b, is in keeping the uppermost end of the first knot still uppermost when making the second one. In pulling the ends of the ligature, to tighten the knot, always have the direction of the force downwards, or towards the ves- sel. You will thus avoid jerking the noose from the vessel should the fingers slip from the thread, or the thread break. CLOVE-HITCH KNOT. Description —A strong crash towel is about as good as any- thing for making this knot. Previous to its application the part over which it is to be applied should be enveloped with a wet piece of lint; this serves the double Yig. 138. purpose of protecting the limb from excoria- tion, and of preventing the slipping off of the knot from the extremity when making traction. Application.—Place one of the extremi- ties of the towel, or cravat, over the back of the forearm, for example, as at 1; pass now the other extremity down across the arm, and up over (diagonally from below upwards) the one first applied, as at 2. As- ciove-nitch 156 MANUAL OF BANDAGING. cend the arm a little space, and then make another horizontal turn about it, bringing the end up under the course 2, thus fin- ishing course 3. Uses.—For extension 6f a member during reduction of a dislocation; more especially applied to the superior extremity. M. GERDY'S EXTENSION KNOT. Description.—This knot is executed with a cravat one and one-half yards in length; the length, however, varying accord- ing to the purposes for which it is employed. Application.—Place the centre of the cravat upon the tendo Fig. 139. Achillis, just above the ankle joint, having the dorsal surface of the foot towards you; then bring the two ex- tremities of the cravat forwards, cross- ing them upon the front of the tibio- tarsal articulation, 1'; .carry the two ends downwards to the plantar surface of the foot, recrossing them to carry them up, 2, 2', in front of the malleoli, and under the crossed extremities 1, 1'; then bring them downwards, as 3, 3', to fasten as required. Variety. — Instead of putting the M.Gerdy's Extension Knot. „, , ,, ,, , courses 2, 2, beneath the crossed ex- tremities, 1, 1', from below upwards, carry them up across these courses, and pass them, from above downwards, beneath the courses 1, 1'; afterwards make a final fastening as desired. See, also, Figs. 133 and 134, when extension is to be kept up for any great length of time. Uses.—For extension of the lower extremity, as in dressing fractures; the counter extension being made by the perinaeal band, or inclination of the bed. INDEX. Adductor Bandago of the Big Toe, 97. Adhesive Bandages for Retaining Splints, 152. Anterior Figure of 8 of the Shoulders, 94. Star Bandage, 94. Thoracico-Scapular Triangle, 84. Ascending Spica of the Groin, 118. Spica of the Shoulder, 86. Pandages, classification of, 30. Compound, 30. in General, 34. of the Body, 81. of the Head, 32. of the Neck, 53. of the Lower Extremity, 97. of the Upper Extremity, 60. Simple, a0. Tearing of, 26. Bavarian Plaster Splint, 127. Bi mammary Triangle, 92. Binocle, 35. Boullette, a, 18. Bourdonnet, a, 19. Bourse of the Mamma, 90. of the Scrotum, 125. Caputina, 114. Carpo-Digito Palmar Triangle, 66. Dorsal Triangle, 67. Carpo-Olecranon Cravat, 70. Cataplasmata, 13. Cervical Cravat, 53. Cervico-Ulnar Cravat and Triangle, .4. Charpie, 18. „ QO Circular of the Forehead and Eyes, 32. of the Neck, 53. Circular-Quadrilateral of the Abdomen, and the Dorsal Cervico-Sternal Tr.- onhe Chest, and Dorsal Cervico-Sternal Triangle, 82. of the Abdomen and Thorax, and the Dorsal Cervico-Sternal Triangle, 83. Clove-hitch Knot, 155. Compound Bi-Axillary Cravat. 8i. Dorsal Bi Axillary Cravat, 94. Fractures, Treating, 134. Sternal Bi-Axillary Cravat, 96. Compress, 21. Buttonhole, 23. Circular, 22. Complex, 22. Perforated, 23. Rectangular, 21. of Six Heads, 22. Sling, 22. Three Heads, 22. Triangular, 22. Cotton-Wool, 18. Coxo Pelvic Triangle, 123. Cravat of the Knee, 102. of the Neck and Axilla, 85. Cross of the Chin, 37. of the Eye, 34. of the Eyes, 36. Ascending, of the Groin, 118. Descending, of the Groin, 119. of the Head, 40. of the Head, Mayor's, 44. of One Mamma, 88. Posterior, of the Head and Neck, 51. of the Occiput, 51. of the Two Mammae, 91. Cruro-Inguinal Triangle, 120. Pelvic Triangle, 120. Pelvic Cravat, 121. Descending Spica of the Groin, 119. Spica of the Shoulder, 86. Directions for Medicated Plasters, 153. Double T of the Nose. 47. of the Perinseum, 122. of the Toes and Ankle, 98, of the Trunk, 126. Emplastrum Resinse, 144. Extension Apparatus, 150. Knot, 156. Fenestrated Immovable Dressings, 132. Figure-of-8-Bandage of the Extremities, 109. Anterior of the Elbow, 73. Posterior of the Elbow, 73. Anterior of the Head and Axillae, 55. Extensor of the Hand upon the Fore- arm, 69. Flexor of the Hand upon the Fore- arm, 70. of the Foot and Ankle, 99. Anterior of the Hand and Wrist, 62. of the Head and Axilla, 58. of the Neck and Axilla, 84. of One Toe, 97. Posterior of the Hand and Wrist, 61. Posterior of the Thumb and Wrist, 61. Posterior of the Head and Axillae, 53. of the Shoulder and opposite Axilla, 86. Spiral of Extremities, 107. Fillet, or Headband, 33. Four-tailed Bandage of the Chin, 89. of the Hand, 63. of Head and Neck, 52. of Heel, 100. of the Hip, 123. of the Instep, 100. of the Knee, 104. of the Leg, 109. of the Shoulder, 75. ( Fronto-Cervico-Labial Triangle, 51. Dorsal Triangle, 55. Occipital Triangle, 3.. Oculo-Occipital Triangle, 36. [157] 158 INDEX. Galen's Bandage, 46. Gateau, a. 18. Gauntlet of the Hand, 67. of the Foot, 98. Gerdy's Extension Knot, 156. Hamilton's Splint for the Patella, 106. Handkerchief Head Bandage, 47. Hare-lip Bandage, 49. Headband, Mayor's, 36. Hip-joint Troubles, Treatment of, 135. Immovable Dressings, 127. Fenestrated, 132. Removing, 133 Inguinal Cravat, 121. Invaginated Roller of Upper Lip, 49. of Under Lip, 50. Jury Mast, Sayres', 138-140. Walker's Modification of, 141. Knotted Bandage of the Head, 41. Knots, 154. Large Oblique Triangle of Arm and Chest, 75. Lateral Bandage of the Neck, 58. Triangle of the Neck, 58. Lumbo-Scrotal Triangle, 124. Maltese Cross, 25. for Arm Stump, 113. for Leg Stump, 113. for Thigh Stump, 113. Manila Paper Splints, 143. Mayor's Invaginated Bandage of Upper Lip, 51. Monocle, 34. New Extension Apparatus, 150. Occipito-Auricular Triangle, 44. Mental Triangle, 39. Sternal Triangle, 57. Parieto-Axillary Triangle and Cravat, 58. Paraffin Bandage, 132. Pelote, a, 19. Perforated Spiral of the Inferior Extrem- ity, 111. Perinaeal Cravat, 122. Plasters, Medicated, 153. Plaster Bandage, Sayre's,f or the Spine, 137, Dressing, Pirogoff's, 129. Roller, 130. Splint, Bavarian, 127. Plumasseau, a, 18. Popliteal Cravat, 102. Porous Cross of the Mamma, 89. Posterior Double Figure-of-8 of the El- bow and the Opposite Axilla, 77. Posterior ITigure-of-8 of the Knee, 101. of the Shoulders, 92. Poultices, 13. Medicated, 14. Poultice—how to Apply, 14. how to Make, 13. how to Spread, 13. Bread and Milk, 17. Charcoal, 15. Chlorine, 17. Hemlock. 16. Mustard, 16. Oakum, 17. Recurrent for Amputated Arm, 112. for Amputated Forearm, 112. for Amputated Leg, 111. for Amputated Thigh, 111. Bandage of the Head, 45. Reef Knot 154. Removing Immovable Dressings, 133. Reversed Spiral of the Inferior Extrem- ity, 110. Roller, a, 25. how to Make, 26. how to Apply, 28. how to Confine, 29. Roller Cap of the Head, 45. of the Knee, 103. Roller of the Chin, 37. Rosette Stump Dressing, 114 Sacro-bi-crural Cravat, 121. Sacro-pubic Triangle, 123. Sanborn's Splint for the Patella, 104. Sayre's Clavicular Plaster Splint, 78. Plaster Bandage for the Spine, 137. Scapulo-tibial Triangle and Cravat, 117. Scultet's Bandage, 132. Sheath of the Fingers, 69. of the Foot, 101. Silica Bandage, 132. Jacket, 142. Simple Bi-Axillary Cravat, 86. Dorsal Bi-Axillary Cravat, 93. Sternal Bi-Axillary Cravat, 95. T of the Perinaeum, 122. Six-tailed Bandage of the Head, 46. Skull-Cap, 32. Sling of the Chin, 39. of the Hand, 63. of the Head, 46. of the Heel, 100. of the Instep, 100. for the Inferior Extremity, 117. Small Front of the Hand or Forearm, 76 Sling of the Hand, 76. of the Occiput, 52. Spica of the Shoulder, 84. of the Thumb, 61. of the Toe, 97. Spinal Troubles, Treatment of, 137. Spiral of the Arm, 74. of all the Fingers, 67. of all the Toes. of the Chest, 81. of the Fingers and Hand, 68. of the Foot, 99. of the Forearm, 71. of the Knee, 104. of the Neck, 53. of one Finger, 60. of one Toe, 97. Reversed of the Superior Extremity, 71. Simple of the Leg, 106. Simple of the Thigh, 107. Reversed of the Leg, 107. Starch, or Plaster Roller, 130. Strapping for the Breast, 148. for Foot and Ankle, 145. for Wounds, 146. for Testicle, 147. for Extension of the Leg, 149. for Varicose Ulcers, 151. Strappings, 144. Surgeon's Knot, 154. T of the Head and Ear, 42. of the Mouth, 48. Double Anterior of the Hand and Wrist, 65. INDEX. 159 Ti Double of the Back of the Hand and Wrist, 63. Double Anterior of the Head and Tho- rax, 56. Double Posterior of the Head and Tho- rax, 55. Perforated of Head and Ear, 43. Single of the Back of the Hand and Wrist, 64. Single Anterior of the Hand and Wrist, 65. of the Temple, 42. Tampon, a, 19. Tarso-Crural Cravat, 116. Tarso-Patellar Cravat, 115. Tarso-Pelvic Cravat, 116. Temple Bandage, 40. Tents 19 Testudo of the Knee, 103. Triangle for Arm Stump, 113. Triangle for Leg Stump, 113. for Thigh Stump, 112. of the Chin, 39. of the Elbow, 73. of the Foot, 100. of the Head. 47. of the Leg, 109. of the Mamma, 90. Triangular Bonnet of the Head, 37. Bonnet of the Nates, 123. Front of the Forearm, 76. Sling of the Arm, 75. Trapezoidal T of the Groin, 119. Treating Compound Fractures, 134. Hip-joint Troubles, 135. Spinal Troubles, 137. Velpeau's Bandage, 79. Walker's Modification of Jury Mast, 141 i NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF no^w ,o Aalaan tv^uvn * »o, *> *Jv..n tvnouvn a« *> «; vaan tvnouvn LtBRARY OF MEDICINE NATIONAL LIBRARY OF ME DICINE NATIONAL LIBRARY OF MEDICINE aNOiaaw JO Aavaan tvnouvn 3nidiq3w jo Aavaan tvnouvn 3NO.03W jo Aavaan tvnouvn NATIONAL LIBRARY OF MEDICINE NATIONAL L.BRARY OF M EDICINE NATIONAL LIBRARY OF MEDICINE 3NOIQ3W jo Aavaai t tvnouvn " 3NOia3w jo Aavaan tvnouvn 3no,q3w jo Aavaan tvnouvn NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 3NOIQ3W jo Aavaan tvnouvn 3no.03^ jo Aavaan tvnouvn 3noiQ3w jo Aavaan TVNOuvr- national library of medicine national ubrar Y OF MEDICINE NATIONAL LIBfA-Y OF MEDICIN 3NOia3w jo Aavaan tvnouvn 3NOia3w jo Aavaan tvnouvn 3nidio3w jo rivaan tvnou-. NATIONAL LIBRARY OF M EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI OlClNE NATIONAL LIB' A<-'< OF MEDICI / - v Ln oosbo^ o ■.-, '." V,■■"•'- NLM005604540