COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX00034320 ^9::r4. J ' <'.; ^: C' /l^' .|^,. -....i^Y^^.r....;.. Columbia ^nibersiitp in tfje dtp of j^eto ^orfe ^tijool of ISental anb (!^ral ^urgerp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/manualofbandagiOOIeon J^ 3s^-A.IsrTJJ^Ij BANDAGING ADAPTED FOR SELF-INSTRUCTION. By C. HENRI LEONARD, M. A., M. D. WITH OVER ONE-HUNDRED ILLUSTRATIONS. DETROIT: DAIT. Y POST BOOK PRINTING ESTABLISHMENT. 1876. Entered according to Act of Congress, in the year 1875, By C. HENRI LEONARD, in the ofl&ce of the Librarian of Congress at Washington. The Multum in Parvo Dose Book. BY C. HENRI LEONARD, M. A., M. D. Second Edition, Revised and Enlarged. Paper, 60 cts.; Cloth, 75 cts. Contains the doses of more remedies than any other Dose Book or Materia Medica published, and is used in nearly every Medical College of the United States, and by Physicians and Druggists in every State and Territory, and the Canada s. CONTENTS: Medium and maximum Doses of all officinal and nonofficinal remedies and their preparations (emetic doses indicated , arranged in alphabetical order : Pro- nunciation of each : the Orthography that of the last U. S. P. The nonofficinal reme- dies are indicated. Pull list of Preparations, as waters, plasters, pills, etc., and pronunci- ation. Rules for Genitive-case endings in prescription writing. A complete list of I^f- . COMPATIBLES Ditto of Polsous and their AntidotE'^, and Tests for each. Also rules for resuscitation of the drowned, treatment of poisoned wounds, etc. Complete table of Tests for Urinary Deposits, chemical and microscopical. Full series of Obstetric Tables, and rules for management in difficult cases and accidents. Pronunciation of Medico-Biogra- phical Names. Table of Fees for city and country practice, taken from the Philadelphia Detroit, and ^ew Jersey lists. Series of Vis^ceral Measurements as guides for auscultation and percussion. The National Code of Ethics (condensed), and the Hippocratic Oath. Table of the Exanthemata, and differential diagnosis Tables of Weights, Measures, both French and American, and for apportioning doses, etc. List of Abbreviations, be- sides several pages of miscellaneous matter, useful in emergencies, accidents, etc. What THE Press say: " Is emphatically a multum in parvo * * * and contains a fund of valuable information of every day requirement. * * Besides being the most complete Dose Book we knew of, it is indispensable to the practitioner on account of its other contents." — Peninsular Journal of Medicine. " Every one must acknowledge that this author has compressed an immense amount of ready practical information into the minimum of space."— CAzca^o Medical Journal and Examiner. "Is just what every physician and druggist should have in his pocket for immediate Teterence." —Michigan Farmer. THE YEST-POCKET jlNATOMIST, By C. HENRI LEONARD, M. A., M. D. ^Enlarged Edition — Paper 50 cents. Used in nearly every Medical College of the United States. CONTENTS ; Each Bone : its name ; pronunciation ; the points of interest ; the num- ■ ber and names of muscles attached (those of insertion being indicated by different type); number of articulations, and names of bones articulating; number of developmental centers, and time of first appearance. Each Muscle: its name ; origin; insertion ; ner- vous supply ; pronunciation, etc. Each Artery : its name ; number of branches, from main vessel ; pronunciation of each : origin ; course ; structures supplied ; anastomosis. (Given in successive order of origin ; the main vessels indicated by larger tpye.) Each VBiNf : its name ; pronunciation ; course ; where emptying ; vessels received ; number of valves etc. Each Nerve : its name ; pronunciation ; origin ; course ; branches : distribution ; anastomosis, etc. (Main branches indicated by larger type.) Complete resume Table of the bones. Classified Table of the actions of the muscles. " Brief, comprehensible, and to the point ; in fact it is ' Gray ' and ' Wilson ' in a " short dress." The departments named are complete / something you cannot say of the small anatomies heretofore issued." — Medical Observer. I^^Either book will be sent post-paid upon receipt of price by addressing the Publisher, C. HENRI LEONARD. M. D., 3SS Woodward Avenue, Detroit, Mich. ¥l)e ">Cultuin ill f^kfYo" ^erie^. t ^ > The Multum in Parvo Dose Book. Paper, 60 cts. Cloth, 75 cts. THE VEST-POCKET ANATOMIST. Paper, 50 cts. MANUAL OF BANDAGING Fmlly lll'iiiBtTated, Cloth, $1.50. Any of the above sent post-paid upon receipt of price by C. HENEI LEONARD, M. D., Detroit, Mich. R-egu-lar Discou-iit to the Trade. Depots. — Eastern : D. Appleton & Co., New York City ; J. B. Lippincott & Co., Philadelphia ; James Campbell, Boston. Southern: J.P.Morton & Co., Louisville. Western : Bancroft & Co., San Francisco. :pi^:hi:f'^^c:h], In the issue of this httle 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 cursory 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 Surgery," 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 bandages. 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 possible ; thus making the book consist of the simple and more useful bandages, rather than those after the "fancy" and ornate order. 6 PREFACE. 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 "Immov- able Bandages," are so intimately connected with the subject treated of at length, that it was thought advisable to introduce a iew 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 author has adopted dressings from other sources as well. He is also under great obligations to Prof 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. 353 Woodward Ave,, .January 1st, 1876. C. H. L. OOISTTEHSTTS CHAPTEE I. Charpie and Cotton-wool : A Plumasseau. A Gateau. A Boulette. A Boiirdonnet. A Tampon. A Pelote. Tents Page 13 CHAPTER II. CoMPKESSES : The Square. The Graduated. The Triangular. The Rectan- gular. The Circular. The Complex. Those of Two, Three, Four, and Six Heads. The Button-Hole. The Perforated Page 16 CHAPTEE III. Bandages in General : Maltese Cross. A Eoller. How to Make, Apply and Confine a Eoller Page 19 CHAPTEE IV. Classification of Bandages: Simple Bandage. Compound Bandage. Eegional Classification Page 24 CHAPTEE V. 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-occipital Triangle. Occipito- frontal Triangle. Biparietal Triangle. Simple Cross of the Chin. Four-tailed Bandage of the Chin. Occipito-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. 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 Eoller of the Upper Lip. Invaginated Eoller 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 26 8 CONTENTS. CHAPTEE VL Bandages of the Neck : Circular of the Neck. Cervical Cravat. Poste- rior Figure of 8 of the Head and the Axilla? Double Posterior T of Head and Thorax. Fronto-dorsal Triangle. Anterior Figure of 8 of the Head and the Axillae. Double Anterior X of the Head and Thorax. Occipito-sternal Triangle. Figure of 8 of the Head and Axilla. Parieto- axillary Triangle and Cravat Page 47 CHAPTEE Vn. Bandages of the Upper Extremity : Spiral of One Finger. Posterior 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 X of the Back of the Hand and Wrist. Perforated X of the Hand and Wrist. Carpo-digito-palmar Triangle. Double Anterior X of the Hand and Wrist. Single Anterior X 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 Ex- - tensor of the Hand upon the Forearm. Figure of 8 Flexor of the Hand upon the Forearm. Carpo-olecranon Cravat. Flexor Carpo-olecranon Cravat. Simple Spiral of the Forearm. Eeversed Spiral of the Superior Extremity. Anterior Figure of 8 of the Elbow. Posterior Figure of 8 of the Elbow. Triangle of the Elbow. Four-tailed Bandage of the Elbow. Cervico-ulnar Cravat and Triangle. Spiral of the Arm. Four- tailed Bandage of the Shoulder. Large Oblique Triangle of the Arm and Chest. Triangular Front of the Forearm. Small Frcnt of the Hand or Forearm. Posterior Double Figure of 8 of the Elbow and the Opposite Axilla Page 54 CHAPTEE Vni. Bandages of the Body: Spiral of the Chest. Spiral of the Abdomen. Ciicular-quadrilateral of the Chest, and Dorsal-cervico-sternal Triangle. Circular-quadrilateral of the Abdomen, and the Dorsal-cervico-sternal Triangle. Circular-quadrilateral of the Thorax and Abdomen, and the Dorsal Cervico-sternal Triangle. Anterior Thoracico-scapular Triangle. Posterior Thoracico-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. Triangle of the Mamma. Bourse of ihe Mamma. Cross of the Two Mammae. Bimammary Triangle. Posterior Figure of 8 of the Shoulders. Simple Dorsal Biaxillary Cravat. Compound Dorsal Biaxillary Cravat. Ante- rior h igure of 8 of the Shoulders. Simple Sternal Biaxillary Cravat. Compound Sternal Biaxillary Cravat Page 72 CONTENTS. CHAPTEK IX. Bandages op the Lower Extremity : Figure of 8 of One 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 Cravat. An- terior Figure of 8 of the Knee. Cravat of the Knee. Testudo of the Knee. Spiral of the Knee. Four-tailed Bandage of the Knee. Simple Spiral of the Leg. Spiral of the Thigh. Eeversed Spiral of the Leg. Keversed 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. Keversed 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 of the Groin. Cruro-inguinal Triangle. Cruro-pelvic Triangle. Cruro-pelvic Cravat. Sacro-bicrural Cravat. Double X of the Perinseum. Single T of the Perinaeum. Perinseal Cravat. Sacro-pubic Triangle. Four -tailed Bandage of the Hip. Coxo-pelvic Triangle. Lumbo-scrotal Triangle. Bourse of the Scrotum. Double T of the Trunk Page 86 CHAPTER X. Immovable Dressings: The Bavarian Plaster Splint. The Common Plaster Dressing. Starch, or Plaster, EoUer. The Silica Bandage. The Parrafin Bandage. Fenestrated Immovable Dressings. . . Page CHAPTER XL Strappings: For the Foot and Ankle. For wounds. For a Testicle. For the Breast. For Extension of the Leg, Page CHAPTER XIL Knots: The Surgeon's Knot. The Reef Knot. The Clove-hitch Knot. Gerdy's Extension Knot Pao-e CHAPTER XIIL Oataplasmata : Cataplasma Carbonis. Cataplasma Conii. Cataplasma Fermenti. Cataplasma Lini. Cataplasma Sinapis. Cataplasma Soda? Chlorinatae. Cataplasma Panis et Lactis. Oakum Poultice. How to Spread a Poultice. How to Apply a Poultice Page 2 LIST OIF- irjLTJSTI^_A.TIOlNr©. > » Figure. page. 1 Perpendicular section of a Graduated Compress, . . . . 1& 2 Compress of Two Heads, . . . . . . . . 17 3 Compress of Three Heads, . 17 4 Compress of Four Heads, ........ 17 5 Button-hole Compress, 18 6 Perforated Compress, 18 7 Maltese Cross, .20 8 A Eoller, 20 9 How to make a Roller-head, 21 10 Applying a Holler, . . 22 11 Confining a Roller, . 23 12 Circular of Forehead and Eyes, ....... 26 13 Fillet or Head-band, 27 14 Cross of the Eye, 28 15 Cross of the Eyes, 29 16 Fronto-oculo-occipital Triangle, 30 17 Fronto-occipital Triangle, 31 18 Simple Cross of the Chin, ........ 32 19 Four-tailed Bandage of the Chin, 33 20 Occipito-mental Triangle, 34 21 Cross of the Head, 35 22 Knotted Bandage of the Head, 36 23 The T of the Head and Ear, 37 24 Perforated J of the Head and Ear, 38 25 Recurrent Bandage of the Head, 39 26 Diagram of the Six-tailed Bandage of the Head, ... 40 27 Six-tailed Bandage of the Head, 40 28 Triangle of the Head, 41 29 Double T of the Nose, 42 30 T of the Mouth, 43 31 Invaginated Roller of the Upper Lip, ...... 44 32 Fronto-cervico-Iabial Triangle, 45 MANUAL OF BANDAGING. 11 FIGURE. • PAGE. 33 Posterior Cross of the Head and Neck, 46 34 Posterior Figure-of-8 of the Head and Axillje, . . . . • 48 35 Double Anterior T of the Head and Thorax, . . . .50 36 Occipito-sternal Triangle, . . . . . . ' . . 51 37 Figure-of-8 of the Head and Axilla, 52 38 Parieto-axillary Triangle and Cravat, 53 39 Spiral of One Finger, 54 40 Posterior Figure-of-8 of the Thumb and Wrist, .... 55 41 Posterior Figure-of-8 of the Hand and Wrist, . . . . 56 42 Diagram for Double T of the Back of the Hand and Wrist, . 57 43 Double T of the Back of the Hand and Wrist, .... 58 44 Diagram of the Perforated T of the Hand and Wrist, . . 59 45 Perforated T of the Hand and Wrist, 59 46 Carpo-digito-palmar Triangle, 60 47 Spiral of All the Fingers, 61 48 Spiral of the Fingers and the Hand, 62 49 Figure-of-8 Extensor of the Hand upon the Forearm, . . .63 50 Carpo-olecranon Cravat, ........ 64 51 Anterior Figure-of-8 of the Elbow, 66 52 Cervico-ulnar Cravat and Triangle, 67 53 Large Oblique Triangle of the Arm and the Chest, . . .68 54 Triangular Front of the Forearm, 69 55 Small Front of the Hand or Forearm, 70 56 Posterior Double Figure-of-8 of the Elbow and Opposite Axilla, 70 57 Spiral of the Chest, 72 58 Circular-quadrilateral of the Chest, and Dorsal Cervico-sternal Triangle, 73 59 Anterior Thoracico-scapular Triangle, . . . . , 74 60 Figure-of-8 of the Neck and Axilla, 75 61 Figure-of-8 of the Shoulder and Opposite Axilla, ... 76 62 Simple Biaxillary Cravat, 77 63 Compound Biaxillary Cravat, 78 64 Cross of One Mamma, 78 65 Triangle of the Mamma, 79 66 Diagram of the Bourse of the Mamma, 79 67 Bourse of the Mamma, 80 68 Cross of the two Mammte, SO 69 Posterior Figure-of-8 of the Shoulders, 81 70 Simple Dorsal Biaxillary Cravat, 82 71 Compound Dorsal Biaxillary Cravat, 83 72 Anterior Figure-of-8 of the Shoulders, 84 73 Figure-of-8 of the Foot and Ankle, 87 12 LIST OF ILLUSTRATIONS. FIGURE. PAGE. 74 Triangle of the Foot, 88 75 Posterior Figure-of-8 of the Knee, ...... 89 76 The Popliteal Cravat, 90 77 Testudo of the Knee, 91 78 Four-tailed Bandage of the Knee, . 92 79 Figure-of-8 Spiral of the Extremities, 93 80 Figure-of-8 Bandage of the Extremities, 94 81 Triangle of the Leg, 95 82 Reversed Spiral of the Inferior Extremity, . . . . .96 83 Eecurrent for Amputated Thigh, 97 84 Triangle for Thigh Stump, 98 85 Maltese-cross for Thigh Stump, 98 86 Diagram for Caputina, 99 87 Caputina Applied, . 100 88 Tarso-patellar Cravat, 101 89 Scapulo-tibial Triangle and Cravat, 102 90 Sling of the Lower Extremity, 103 91 Cross of the Groin, 103 92 Trapezoidal T of the Groin, . 104 93 Cruro-iuguinal Triangle, 105 94 Cruro-pelvic Cravat, . . . . . . . . .106 95 Sacro-bicrural Cravat, . 106 96 Double T of the Perineum, 107 97 Sacro-pubic Triangle, ... 108 98 Coxo-pelvic Triangle, . . .109 99 Lumbo-scrotal Triangle, . . . ' 109 100 Bourse of the Scrotum. . . . . . . . .110 101 Double T of the Trunk, Ill 102 The Bavarian Plaster Splint, 113 103 Strapping for the Foot and Ankle, 118 104 Strapping for Superficial Cuts, 119 105 Strapping for Deep Cuts, 119 106 Strapping for a Testicle, 120 107 Strapping for Extension of the Leg, ...... 122 108 (a) The Surgeon's Knot, (b) The Eeef Knot, .... 123 109 The Clove-hitch Knot, 124 110 M. Gerdy's Extension Knot, 125 A MANUAL OF BANDAGING. CHAPTER I. 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 mattings has, at present, induced most surgeons to substitute for it clean cotton-wool. Charpie, or cotton-wool is used in surgery to protect from irrita- tion, to compress, and to slightly irritate, as well as to maintain in equal temperature a wounded member : one of its most common uses is, however, as an absorbent of the secretions from a wounded surface. For these multitudinous uses it is employed under the forms oi plumasseaux, gateaux, botdettes, bourdonnets, tampons, pelotes, and layers or lamificz. A Plumasseau (a pledget) — is but a bunch of charpie which has been drawn lengthwise lightly through the fingers till the fila- ments 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 compression, 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 3 14 CBARPIE— COTTON-WOOL. the mass. Is used more especially for compression and for absorb- ing the secretions from a 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. They should be soft, elastic and loosely made. Are used for cleansing, or as carriers of sundry medicaments. A Bourdonnet (a dossil or lu^np of lint) — is a small plumas- seau tied closely around the middle, giving it an hour-glass shape. Used as a compress or as a slight tampon in cases of hemorrhage. 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 prepared best 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 surrounding piece of lint, till you get the requisite amount of compression. 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 htemorrhage. Tents — have also been made of charpie by taking the long fibres of it, doubling in the middle, and then crowding it into the wound. But in our day of sponge tents, and the laminaria digitata^ MANUAL OF BANDAGING. 15 such a use of it will not be thought of save, in a case 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 Chapter II). Still, some surgeons prefer the charpie, or even oakum dressing, to any other. 16- comphesses. CHAPTER II. OF COMPRESSES. These are best made of the " surgeon's Hnt " cloth, it giving 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. We 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 of a succession of smaller pieces to a pyramidal 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 stitched through and through, in two or three places, so as to prevent the pieces becoming displaced. Perhaps as simple a 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 longitudinal 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, re- versing the motion of the hand, and so on. Fig. i will give an idea FIG. I. of the manoeuvres indicated, as the compress is seen on an exaggerated perpendicular section, a is the initial, B, the final end. In this case some stitches will be needed to confine the folds securely. The Triangular and Rectangular are but modifications of the above, and need no further description. The Circular is, as its name indicates, a circular piece of " surgeon's lint." We have three varieties of the circular compress : I St, the clipped; 2d, \he perforated ; and 3d, \ht graduated. The first MANUAL OF BANDAGING. 17 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 punc- ture 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 fenestrated compresses, and those of two or more heads, are meant to be in- cluded, whether they be 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, 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. The Button-hole Compress is one that has two or more sUts 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 scis- sors. Fig. 6 will give you an idea of this. Is especially useful as a dressing for di. freely suppurating surface. 18 COMPBESSES. FIG. 6. 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 something 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 mo dify it to suit the exigencies of his case. MANUAL OF BANDAGING. 19 CHAPTER III. ON BANDAGES IN GENERAL. Hippocrates has said that in bandaging there is a two-fold pur- pose to be kept in view; viz.: " that which regards it while doing, ~ and that which regards it when done. It should be done quickly j without pain, with ease, and with elegance ; quickly, by dispatching > the work ; without pain, by being readily done ; with ease, by being I prepared for everything ; and with elegance, so that it may be pleasing J to the sight." There could, perhaps, be no more terse and comprehensive rules to be kept in mind as regards bandaging, than those 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 ad- joining parts from separating, without compressing 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 recommend it to your most earnest consideration. 20 BANDAGES IN GENERAL. 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 toAvards the centre of the piece, giving you when completed the form FIG. 7. seen in Fig. 7. Another way of forming it is, to double the square piece of lint at its middle, then, transversely 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 wiU 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 rol- ler, as ready for use. The part A is known as the head ; the part B as the initial end. Figure 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 the work. A single- headed roller is much more easily appHed, 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, z. plane, c; an internal surf ace, Cj dcn. external surface; d, superior and an inferior border. MANUAL OF BANDAGING. 21 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 proper- ly 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 require 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 continually 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. 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 be- tween 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. 8) of the bandage being up. The unwound portion is grasped by the right hand and allowed to fall in between the thumb and forefinger, as seen in Fig. 9. (Some surgeons ^i<^- 9. prefer to have it fall in between the first and second fingers, the I thumb crowding in closely to the "head" of the bandage.) This I done, holding the bandage quite firmly, yet loosely enough to slip, between the thumb and finger, I the thumb hugging tightly the head", by a downward or supine motion of the right hand, you 22 BANDAGES IN GENERAL. partially circle the forming roller-head, the ring-tinger 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 possible, 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 perfectly immovable, the right per- forming 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. How to Apply a Roller. — To be appHed easily it must be wound evenly and tightly. Hippocrates said, " the turns of a band- age should be made firom right to left, and left to right, except on the head, where they should be in a straight or vertical direction." I would simplify this by allowing the surgeon to suit his own con- venience, remembering only to place the external surface of the ini- tial 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, over- lapping the initial end completely or partially, as you see in turns i and 2 in Fig. lo. Make, then, one or two circular turns, as 3 and FIG. 10. 4, firmly and evenly sweeping around the limb, each overlapping the preceding course about one-third the width of the bandage. "The reverses" \i\i\Q}i\ should always be made whenever the part to be bandaged assumes anything of a pyramidal or conoidal contour, as they keep the bandage firom 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 of the right hand, turn MANUAL OF BANDAGING. 23 the bandage over eftd for end, by the right hand fingers, and bring what was the suj>erior border of the bandage down to the top of the left hand's finger, or fingers that are 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 : ist. Keep the bandage always tight and with equal ten- sion at every turn. 2d. Bring it up somewhat diagonally, before making the reverse, and carry it down diagonally (the opposite of the other) after the reverse is made, as you see in the figure. 3d. Always have the edges of the overlapping 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, that your hands may not learn some bad tricks that must be un- learned them before they will apply one smoothly and nicely. Festina 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 imperfectly 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 in Fig. 11. FIG- 11. Then, introduce your pin (riot per- pendicularly but) in a direction con- trary 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 neces- sary. 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. 24 CLASSIFICATION OF BANDAGES. CHAPTER IV. CLASSIFICATION OF BANDAGES. In olden times bandages received their names from four sources. \iz. : I St. Their authors. 2d. Their forms. 3d. Their uses. 4th. From some fancied resemblance to some article, or manoeuvre. Thus we have the Hippocratic rhomb; the crooked nose; the hare; the quadriga, etc., as epidetic terms frequently to be met with on perusal of old authors. Nothing like a classification 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 " com- pressive," "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 for- ward 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 introduced his system of triangular and quadrilateral bandaging, naming them from the anatomical part 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 triangles and quadrilaterals of Mayor, though very con- venient, will hardly come into general use, as it is impossible to get so smooth and nicely adjusted a triangle as a roller. In some cases, as for instance that of an exigency, it is well to understand his system ; as by that you can adapt almost anything to the purpose until a better dressing can be procured. MANUAL OF BANDAGING. 25 All bandages are divisible into two great classes, the simple and the cotnpound. 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 quadri- lateral, invaginated or not, comes under this division. A Compound Bandage can be briefly defined as a bandage made up of two or more pieces of flannel or cotton, whether in strips (rollers), triangles, cravats, or quadrilaterals ; and may be in- vaginated, stitched (as a X)) or modified in any way that the surgeon may see fit. Besides these two general classes we have a regional classifica- tion ; merely, however, for descriptive convenience, as the execution of a bandage is essentially the same in all parts of the body. These divisions are ist. Bandages of the Head. 2d. Bandages of the Neck. 3d. Bandages of the Upper Extremity. 4th. Bandages of the Trunk. 5 th. Bandages of the Lower Extremity. This general plan of description we 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 Gerd/s system (the roller bandages), as before. 26 BANDAGES OF THE HEAD. CHAPTER V. 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 band- age is also more equable. CIKCULAE OF THE FOKEHEAD 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 i at or near the centre of FIG. 12. 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, cover- Circuiar of the Forehead and Eyes ing 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 starting 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 MANUAL OF BANDAGING. 27 of the eyes and nose, and nasal passages, it serves 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 inferior 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 centre FIG. 13. of the bandage over the face, covering it from the mouth up ; the nose being permitted to pass through the triangu- lar opening. Carry each end horizon- tally backwards about the head, and confine with pins or stitches. Uses. — This bandage admirably takes the place of the preceding 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, The Fillet or Head-band. SOOn tO be treated of A '' S/ing'' and a " Triangle" of the face have been devised, but are really not so convenient as the Fillet. The former is a four-tailed bandage (made similarly as the Sling Compress, Fig. 4, page 17). 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. 28 BANDAGES OF THE HEAD. 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 be- FiG. 14. hind your patient, place the initial end ol the roller, i, above the right eye> previously protected by a compress or some cotton-wool. Confine this by one horizontal circular turn, 2, about the head and continue on till you come to the occiput, for the next turn ; here you make a pass downwards, coming along under the right ear, then up over the inferior angle of the inferior maxilla of the right side, and across the inner angle of the orbit, finishing the third Cross of the Eye. coursc of the bandage. Continuing on 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 I 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 preceding turn. Course 6 is executed the same as course 4, remembering the overlapping. Finally, when you come near the terminal end of your bandage, con- fine by one or two circular turns about the forehead and occiput, following courses i and 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 overshp each other, especially if put on a patient that is not very quiet. A light compress or cotton-wool should fill up the MANUAL OF BANDAGING. 29 orbital cavity, thus not only keeping the lids securely closed, but it will steady the eye-ball in its socket, as well as produce slight com- pression. In the case of the left eye, the proceeding is the same, reversing only the direction of the courses. For 7%(? Triangle of the Eye, see " Uses " under the bandage Fronto-oculo-occipital Triangle, page 30. CROSS OF THE EYES. (Binocle.) Description. — This bandage should be eight yards in length and have a width of from one and a half to two inches. Application.^ — Standing behind your patient, place the initial FIG. 15. end of the bandage, i, over his right eyebrow, and confine there by a hori- zontal circular turn about the head, 2. On the third turn, when coming to the occiput, pass the bandage down so as to come around under the right ear, up over the inferior angle of the lower maxilla, and up over the inner angle of the orbit of the right side, thus finishing the third course of the bandage. From this point carry the bandage up over the left parie- Cross of the Eyes. tal eminence, then down to the occiput, and finally horizontally about the head, thus finishing course 4. Continue the course of the bandage horizontally about the head un- til you come to the occipital 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 i and 2, when you finish course 6 as a horizontal turn about the head. 30 BANDAGES OF 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 over- lapping its underlying fellow by one-fourth, or one-third its AAidth. 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 protu- berances are the main points of support to these ocular bandages ; hence pay particular attention to the "laying of the bandage" about these parts. FKONTO-OCULO-OCCIPITAL TKIANGLE. (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 of FIG. 16. 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 occiput, 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 occiput up over the horizontal courses of the two extremities to the region of the Fronto-Oculo-Occipital Triangle r v j j r -^i 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 MANUAL OF BANDAGING, 81 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 28. It is not so firm, or evenly compressing a bandage, as the two preceding, and hence would not be so appli- cable 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 application of this triangle, just as in the Crosses of the eyes. FRONTO-OCCIPITAL TEIANGLE. (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 I'lG- 17. the triangle, i, at the forehead, over the eyes, having the apex at the occiput. Carry the two extremities 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. Fronto-occipitai Triangle. Modifications.— I. By reversing the application of this bandage, putting the base at the occiput and the apex at the forehead, you get the Occipito-frontal Triangle 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 p art ofthe 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. 32 BANDAGES OF THE MEAD FIG. IS. 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. Application. — Standing at your patient's back, place the initial end of the bandage, i, over the left eyebrow, and confine 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, fin- ishing 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- 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 fron to-occipital horizontal turn 7. Then continue on to the occiput, down below the right ear, across the symphysis of the chin, making turn 8. Circle the chin again, hori- zontally (turn 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 II 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 turn, 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. ^jiiiipie C'rosa of the CMn. fourth the width of the bandage. MANUAL OF BANDAGING. 33 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. FOUR-TAILED BANDAGE OF THE CHIN. (S/ing of the Chin.) Description. — This bandage should be one and one-fourth yards FIG. 19. in length, and have a width of about five inches. It should be torn, at the middle of each end, towards the centre (as you see in Fig. 4, page 17) 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, i, at the chin ; then carry the two superior ends of your band- age backwards, below the ears, to the nape of the neck ; crossing them here, Sling of the Chin. bring 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 confine 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 support to the parts as the preceding, 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. 34 BANDAGES OF THE UEAD. OCCIPITO-MENTAL TRIANGLE. (Mayor's Triangle of the Chi?i.) Description. — ^Have your triangle with a base full one and one-half yards in length, and with a height of twenty inches, or more. Application. — Standing behind your patient, place the base of FIG- 20. 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, crossing them this way, B, b, and then carry them obliquely backwards and upwards across the temporal and mastoid regions to confine them at the summit of the occiput. Con- fine the apex as at d. Occipito-Mentai Triangle. Uscs. — This bandage was de- signed by Mayor to take the place of the two preceding bandages this it does, in a measure, in its ready applicability for the confine- ment of dressings about the regions it covers. It is easily extem- porized, and hence is a "popular" way for maintaining topical ap- plications 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 these 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. MANUAL OF BANBAOINO. 35 Application. — Standing behind your patient, place the initial ^i^« 21. end of the bandage, i, 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 bandage either by stitches, or a pin, inserted perpendicularly to the preceding cour- ses of the bandage. This done, de- scend perpendicularly with the roller- head to the posterior angle of the inferior maxilla, covering over the right ear, and, passing under the lower jaw, continue the bandage up over the left Cross of the Head. g^r to the top of the head ; then de- scend to the horizontal courses of the bandage, thus completing course 4. Turns 5, 6, 7 and 8 are to follow in the course of turn 4, viz., perpendicularly around the head, remembering to bring the bandage gradually forwards by overlapping each preceding 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, perpendicularly to the course of turns 6, 7 and 8, the remaining bandage being exhausted by hori- zontal turns about the head and occiput, in the course of turns I and 2. In this application of The Cross of the Head, it has been supposed 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 protection of, or application of dressings to, the ears, temples, parotid or hyoid regions. Is readily applied and makes a firm dressing. 36 BANDAGES OF THE HEAD. KNOTTED BANDAGE OF THE HEAD. Description. — This bandage should be one and a half inches in width and eight or ten yards in length, and rolled into two heads. Application. — Place the plane of the bandage over the injured FIG. 22. temple (the left, for example) and then carry the two heads horizontally about the head to the right parietal region, where you cross one over the other ; continue them on 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 perpen- dicularly over the head, while you carry the other perpendicularly downwards Knotted Bandage of the Head. j ^i, i,- ^- • ^1 ^ under the chm, 3, 3, contmumg the course of each around the head and chin, until they meet at the diseased temple again, thus finishing the third course. Cross them at right angles again at this point, continuing horizontally about the head, as in course i, until you come to the diseased 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 otherwise. 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 Pyrami- dal Compress (see page 16). THE T OF THE HEAD AND EAE. (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 MANUAL OF BANDAGING. 37 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 sixteen or eighteen inches beyond the first or widest portion. Application. — Place the point of juncture of the two bandages, FIG. 23. A, over the right temporal re- gion, if this be the one involved, in such a manner that the widest portion of the bandage, B, shall be perpendicular, as regards the head ; then carry the long end of this wide portion of the band- age, B, down under the chin, and up on the other side to the top of the head, there tying or pinning it to the short end, brought perpendicularly up- wards from the diseased tem- The T of the Head and Ear. , • n-T. ■, j poral region. The longer and narrower portion of the bandage, a, is now to be carried horizon, tally about the head, the long end confining the short one by suc- cessive horizontal courses till it is exhausted, when confine in the usual manner. Uses. — For confining dressings to the temporal, parotid and hyoid regions. PEEFORATED 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 extremity 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 per- forated 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, bringing 38 BANDAGES OF TEE HEAD. FIG. 24, the bandage closely and snug- ly up to the head. Carry the shorter end of the horizontal portion of the bandage smooth- ly around the occiput and forehead, and confine by a single horizontal circular turn, 2. Carry, now, the perpen- dicular portion of the band- age, 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 perpendicular portion of the bandage. Exhaust the remaining 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 blis- ters to the mastoid process, or dressings thereto, as is frequently needed in diseases of the ears. It is equally useful in confining dressings upon the ears, temporal, parotid, and tonsillar regions. Perforated T of the Head and Ear. OCCIPITO-AURICULAE TRIANGLE. (Jlfayor'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 Occi-. pito-mental Triangle (page 34). The only difference being that this one is crossed below, instead of upon, the chin. Uses. — Essentially the same as many of those for which The Knotted Bandage of the Head (page 2i^), The T of the Head and Ear (page 37), and The Perforated X o^ the Head and Ear (page 38) are employed. MANUAL OF BANDAOINO. 39 Recurrent Bandage of the Head. RECUEEENT 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 FIG. 25. plane of the bandage above the eyebrows, carrying each roller head backwards above the ears to the occiput ; cros- sing them there at right angles, carry the inferior portion up over the top of the head, in line of the saggital suture, 2, to the forehead ; this is called the "recurrent" portion. Now carry horizontally forwards the other roller-head, crossing 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 horizontally 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, running 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 con- fining turns of the bandage quite tightly ; and this, from the repeti- tion of these turns so directly above the others, gives to the patient an uncomfortable feeling of tightness and constriction about the 40 BANDAGES OF THE HEAD. head. Besides this, if the wound is very large, it will press upon the bruised portions, and so cause excessive pain, and venous obstruc- tion. In scalp wounds of the top of the head it might be used to good advantage. FIG. 26. SIX-TAILED BANDAGE OF THE HEAD. (Sling of the Head.) 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, i, 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 remov- ing the triangular pieces 1-2-3 ^^^ 3-2-1. The portion 2)~2) should be three inches in width. Application. — Place the plane of the bandage upon the top of the head, the ends Bring the central ends, a, a', directly down Diagram. being at the sides. FIG. 27. Six-tailed Bandage of the Head. 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 posterior ends, c, 'c, horizontally for- wards, 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 MANUAL OF BANDAGING. 41 maintains its position, it may be preferred to the preceding and following. The suggestion that Galen makes (for it is known as his bandage) 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. 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 your patient, place the bandage FIG- 28. over the top of the head, the triangu- lar portion hanging down over the face. Carry the two ends a, a' for- wards 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 up- wards and fold it under the horizontal Triangle of the Head. turns of A, a', 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 in- juries of the upper portion of the head. It is not, however, quite so firm a dressing as the bandage just described. 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. 42 BANDAGES OF THE HEAD. Application. — Standing behind your patient, place the plane FIG. 29. 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 upon each side, along the nose. Carry the heads of the main bandage, a, hori- zontally backwards to the occiput, and cross one head above the other; then take the two perpendicular portions of the bandage, b', b, up over the top of the head, having them cross each other at the root of Double T of the Nose. ^i ^i ^ it, • Ui "n the nose, so that the right will pass over the left parietal region, the left over the right parietal region, and continue their 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 upwards 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 right-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 triangular opening for the nose, cut out a sufficiently large, oval sec- tion to accommodate the mouth and lips. MANUAL OF BANDAGING. 43 Application. — Standing behind your patient, place the plane FIG. 30. of the bandage across the face, so that the oval aperture will correspond to the mouth, and the 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 T of the Mouth. either confine there by pins or stitches; or, after passing under and then over the crossed courses of the main bandage, remount the head and confine at or near the fore- head. This done, carry the ends of the main bandage forwards over the ears and exhaust them by horizontal turns about the forehead 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 plasting operations, or other surgical procedures. This, and the preceding bandage, are especially applicable in cases of transverse wounds of the lip at the nasal alae, or fraenum. INVAGINATED EOLLEE OF THE UPPEE 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 their slipping. 44 BANDAGES OF THE HEAD. Application. — Place the graduated compresses a, a', one upon FIG. 31. each side, in the hollow of the cheeks, below the zygoma, and at about one inch distance from either angle of the mouth, pressing the cheeks and lips well forwards towards the median line. Delivering them to the care of an assistant, take the long compress, e, and place its middle over the summit 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 holding the ends together under the chin. This done, place the invaginaiedRoUer of the Upper pl^ne of the double-headed roller, I, upon Lip. the forehead, standing behind your pa- tient, and carry the heads backwards and downwards to the nape of the neck, here crossing them to carry them horizontally forwards to the superior 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 com- press 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 com- press) 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 eoapted ; 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 Livagitiated Roller of the Under Lip. The only difference in the application being that the pyramidal compresses, a, a', shall be dropped lower, and that the crosses of the bandage 2, 2', and 3, 3', shall take place upon the labium inferius. MANUAL OF BANDAGING. 45 FEONTO-CEEVICO-LABIAL TEIANGLE. (Mayor's Invaginated Bandage of the Upper Lip.) Description. — A square should be folded to a triangle, having a base of forty inches, and a height of eighteen inches. Application. — Place the centre of the base of the triangle upon FIG. 32. the forehead, a, carrying the extremities down and backwards to the nape of the neck, covering over the apex of the tri- angle, there crossing them; then bring them forward over the upper lip, putting one extremity through a slit in the other, as 2, 2'. Carry the ends horizontally back- wards to the nape of the neck, there con- fining them by tying, or otherwise. The apex of the triangle is to be carried direct- ly up over the occiput and pinned at the summit of the head, as at 3. Compresses similar to those used in the preceding can be employed to advantage in this bandage of Mayor's ; and they are especially 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 recommended, in most cases, to take the place of the Roller Invaginated 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, described upon page 44. It is then known as The Invaginated Triangle of the Under Lip. Fronto-Cervico-Labial Triangle. 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. 7 46 BANDAGES OF THE HEAD. Application. — Standing at your patient's back, place the initial FIG. 33. end of the bandage near the occiput, as at I, 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, finishing course 3 ; con- tinue onwards around the neck, making a horizontal circular turn about it for course 4. For course 5, carry the roller- head obliquely up across the occiput, over the right ear, then obliquely down to the Posterior Cross of the Head and nape of the neck, from over the left ear, thus finishing course 6. 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 applications, to bums and other injuries about the occipital region. FOUR-TAILED BANDAGE OF THE HEAD AND NECK. (S/mg 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. Then carry the inferior ends horizontal- ly 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. MANUAL OF BANDAGING. 47 CHAPTER VL BANDAGES OF THE NECK. CIECULAR OF THE NECK. (Spiral of the 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, gradu- ally 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 con- strict 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, probably this bandage of Mayor will be more often used than the preceding. POSTERIOR FIGURE OF 8 OF THE HEAD AND THE AXILLA. Description. — This bandage should be nine yards long by one and three-quarter inches wide. BANDAGES OF THE NECK. Posterior Figure of 8 of the Head and the Axillae. Application. — Standing at the back of your patient, place the ^^®' ^^" initial end of the bandage at the occiput, i, 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 parie- tal protuberance, then down across the neck to the right ax- illa, 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 finishing course 4. Continue the course of the bandage about the forehead, mount the right parietal eminence, and descend diagonally down across the back of the neck to the left axilla, thus 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 pre- ceding 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 degree of backward flexion of the head can be maintained. Note. — Turns 4, 6 and 9 have been exaggerated, at their crossing upon the back of the neck, in order to show their courses more MANUAL OF BANDAGING. 49 plainly. In other words, they are too angular, as represented in the cut. DOUBLE POSTEEIOE T OF THE HEAD AND THORAX. Description. — Same as Double Anterior T of the Head and Thorax, page 50. Application. — The reverse of that bandage, the head being flexed backwards; the application is then essentially the same as seen in cut No. 35. Uses. — The same as those of the Posterior Figure of 8 of the Head and the Axillae, and may be preferred to it. FEONTO-DOESAL TEIANGLE. Description. — The same as the Occipito-Sternal Triangle described on page 51. 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 Posterior 8 of the Head and Axillae, and the Double Posterior "f of the Head and Thorax, which it does admirably. ANTEEIOE FIGUEE OF 8 OF THE HEAD AND THE AXILLA. Description. — This bandage should be nine yards in length by one and three quarter inches in width. Application. — See Fig. 34. This bandage is to be applied just the reverse to this ; 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 bums of the back of the neck, or upper por- tion of the back where vicious cicatricial contraction is to be feared. Also for transverse wounds of the front part of the neck. This band- age is not often employed on account of the inconvenience from the 50 BANDAGES OF THE NECK. 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. 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 distance 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 inter- vening between the two inferior strips. Application. — Encircle the thorax with the broad band, a, con- riG. 35. fining by pins or stitches ; and to it pin the " suspenders " b, b'. This done, place the initial end of the roller upon the forehead, c-i, and confine by a horizon- tal turn, 2 ; carry the single band, d, up over the top of the head and down under the hori- zontal course of the main band- age, at the occiput, again re- mounting the head and confin- ing 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 deem- Doubie Anterior T of the Head and Thorax, ed requisite, and confine it there by pinning the strips e', e, to the thoracic band, a. MANUAL OF BANDAGING. 51 Uses. — Same as those of the Anterior Figure of 8 of the Head and Axillae, and is to be preferred to it. OCCTPITO-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 sternum, FIG- 36. and conduct both ends back- wards, under the axillas, 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 extremities backwards, over the apex of the triangle, to the occiput, crossing them here to conduct them for- wards, and obliquely downwards to the sternum, after having pinned them at the sides of the head. Flex the head sufficient- ly, and then tie them about the Occipito-sternai Triangle. cravat. The apex of the tri- angle can be confined as in ordinary cases. Uses. — Mayor designed this bandage to take the place of the Anterior 8 of the Head and Axillse, and the Double Anterior T of the 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. 52 BANDAGES OF THE NECK. FIG. 37. FIGUKE OF 8 OF THE HEAD AND AXILLA, (Lateral Bandage of the Neck.) Description. — This bandage should be six yards long by one and three-quarters inches wide. Application. — Standing behind your patient, place the initial end, I, at the forehead, and confine by a single horizontal turn, 2. Having arrived at the occiput, on the third course, flex the patient's head on the side injured, the right for in- stance, and carry the bandage down in front of the right shoul- der to the axilla, thus finishing turn 3. Continue the course of the bandage on beneath the right axilla, and up to the fore- head ; here reverse and confine with a pin, thus finishing turn 4. Turn 5 is to be in the course Figure of 8 of the Head and Axilla. ^^ ^^^^ ^^ ^^^^ ^ ^f ^^^^ ^^ ^^d so on. At last exhaust the bandage by horizontal turns about the forehead 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 otherwise persist. PAEIETO-AXILLARY TEIANGLE AND CRAVAT. (Lateral Tria?igle 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. MANUAL OF BANDAGING. 53 Application. — Pass the cravat, a, under the left axilla, supposing FIG. 38. you wish to incline the head to the left, and tie in front of the shoulder. Place the base of the triangle, b, over the left parietal region, and carry the two extre- mities horizontally 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 of the preceding, and is far prefer- able to it, so far as ease of ap- plication and removal is concerned. It is equally efficacious in restraining the movements of the head. May be applied to either side of the head. Parieto-Axillary Triangle and Cravat. 54 BANDAGES OF THE UPPER EXTREMITY. CHAPTER VII. 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. 39. you wish to apply the bandage. Pronate the hand; after unrolling four or five inches of the bandage, place it upon the back of the wrist, as i, and confine it by a single circular 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 band- age onwards along the radial side of the forefinger, you encircle this at the tip, as course 4. Courses 5, 6, 7, 8, 9, 10 and 1 1 encircle the diseased member spirally ; while course 12 runs obliquely upwards, spiraiiof one Finger. ^^^^ ^^^ ^^^^ 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 dressings and splints to the part This bandage is applied to any one of the fingers, or the thumb, of either hand. MANUAL OF BANDAOJNO. 55 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 FIG. 40. hand midway between pronation and su- pination. Unroll four or five inches of the bandage, and thus place it, i, upon the back of the wrist, and confine by two cir- cular turns, 2 and 3 ; continue on in the same course till you come to the ulnar border of the hand, when you descend obliquely across the back of the hand to the radial side of the thumb, at the pha- langeal articulation, thus finishing course 4. Pass under the thumb and then up over it, and diagonally upwards to the radial side of the wrist, finishing course 5. Turns 6, 8, 10, 12 and 14, etc., respec- tively follow the course of turn 4 ; while those of 7, 9, II, 13 and 15, those of turn 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. 56 BANDAGES OF THE UPPER EXTREMITY. Application. — ^Place the initial end, i, on the back of the wrist ^^^- '*^- — the left, for example, — and confine by a circular turn, 2 ; continue the course of the bandage about the wrist till you come to the radial border, when you descend obliquely across the back of the hand to the fifth metacarpo-phalangeal articula- tion, thus finishing turn 3. Turn 4 is a circular course about the metacarpo-pha- langeal articulations ; whilst course 5 ascends obliquely across the hand, from the radial border 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 overlapping it ; course 8, in line of course 4 ; course 9, ot 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 ^vrist, as cataplasma, graduated compresses over ganglionic cysts, etc.; also as an after-dressing after a dislocation backwards 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. ANTEKIOE FIGUEE OF 8 OF THE HAND AND WKIST. 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 41 > 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 ^v^ist ; also, to confine compresses to the region of the palmar arches, in case the vessels are wounded, and ligation is called for. MANUAL OF BANDAGING. 57 FOUR-TATLED BANDAGE OF THE HAND. ( Sling of the Hand.) Description. — -This bandage should be eighteen inches in length by three or four inches in width. Application. — 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 17. 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 metacarpo-phalangeal articulations ; whilst the superior ends you carry obliquely upwards to the wrist, and confined there by tying about it. Uses. — This bandage is intended to take the place of the Pos- terior 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 ap- plied, it has, perhaps, become a more general favorite.* DOUBLE T OF THE BACK OF THE HAND AND WKIST. Description.— The main bandage, a, should be some twenty- FiG. 42. 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 ^"'^l^^'"^ parallel to b, another bandage, c, of the same dimensions as b. Application.— Place the initial end of the bandage, a, upon 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 description of them is thought necessary. 58 BANDAGES OF THE UPPER EXTREMITY. Double T of the Back of the Hand and Wrist. FIG. 43. the back of the wrist, so that the first perpendicular portion of the bandage, B, will correspond to the first interosse- ous 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 finger, and then back, over the second interosseous space, to the wrist; this done, make another circular 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 exhausted, when confine with a pin. Conduct, now, the other perpendicular portion, c, down the fourth interosseous space, across the palmer surface of the metacarpo-phalangeal articulation of the ring-finger, back, over the third interosseous space, to the wrist, here tying with the end 01 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 bums of the palm of the hand, or extensive suppurations, where vicious cicatricial contractions are to be feared. In cases of injuries of the finger-clefts, from bums or otherwise ; here using compresses, soaked in carbolized oil, to prevent the union of the sides of the fingers from " angular " granulation. Also for con- fining 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 desired, and in a manner similar to the above. The uses are similar to the Double f just described, only are more limited. MANUAL OF BANDAGING . 59 Diagram. PERFORATED J OF THE HAND AND WRIST. FIG. 44. 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 perforations ; the first, corresponding, from its size and position, with the thumb, as c. The other perforations are made at such distance from each other, and of such size, as will read- ily admit the fingers. Application.— Suppose it to be the right hand. Carry the FIG. 45. fingers and thumb through their respec- tive perforations in the portion b, and place the portion a at the back of the wrist. Carry forwards the lower portion of B (see figure 44), up across the palm of the hand, folding it about the wrist, as D, d'. Conduct, now, the two extre- mities of the main bandage (a, a', figure 44) circularly about the wrist, binding down the recurrent portion of b (d, d'); and when exhausted, tie the ends to- gether, as at c. Uses. — Designed to take the place of the Double or Single 7" Bandage of the Hand and Wrist ; also for confining Perforated T of the Hand and dressings to the palm of the hand as Wrist. ' 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. 60 BANDAGES OF THE UPPER EXTREMITY. Application. FIG. 46. Carpo-Digifx)-Palinar Triangle. back of the hand. Place' the base of the triangle upon the palmar surface of the wrist ; conduct both extremi- ties circularly 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 confining. Uses.— For maintaining dressings to the palm of the hand, and also for extending 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 In these latter cases it takes the place of the Double X of the Back of the Hand and Wrist. DOUBLE ANTERIOR T OF THE HAND AND WRIST. Description. — The same as the Double T of the Back of the Hand and Wrist (page 57). Application.- — The reverse of the Double T of the Back of the Hand and Wrist ; that is, it is to be applied to the /ro/i/ 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 metacarpo-phalangeal articulations, or transverse wounds across the front of the same joints. 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 desired. The uses are similar to the Double T? o^^Y "^ore limited. CARPO-DIGITO-DORSAL TRIANGLE. Description. — Same as Carpo-Digito-Palmar Triangle. Application. — The reverse of that seen in figure 46, in that you place the base of the triangle at the back of the wrist, confining MANUAL OF BANDAGING. 61 as in the preceding case. Afterwards fold the apex up over the palm of the hand, thus flexing the lingers upon the forearm, and confine at the wrist. Uses. — For maintaining dressings upon the hand, and for main- taining the fingers in a state of flexion when vicious cicatrization 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 "J" of the Hand and Wrist. SPIRAL OF ALL THE FINGEES. (Gauntlet.) Description. — This should be a bandage ten yards in length by three-quarters of an inch in width. Application. — Suppose it be the right hand to which it is to be FIG. 47. 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, i, and confine by the circular turns, 2 and 3 ; after- wards coming obliquely down across the back of the hand, from the radial side, to the little finger, finishing course 4. Con- tinue the bandage outwards to the tip of this finger, making a circular turn, 5, and the spiral turns 6, 7, 8, 9, 10, 11, 12, 13 and 14 about the same member ; then conduct the bandage up- wards and outwards from the Spiral of all the Fingers. c ^\. c ^ c^ . .\ 1 fourth finger-cleft to the palmar surface of the wri^t, thus finishing course 15. Course 16 is essen- tially 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 bandage is similar to that ot course 15. Each of the remaining 9 62 BANDAGES OF THE UPPER EXTREMITY. fingers are similarly wound, and at last both ends of the bandage 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 vicious cica- tricial contraction is to be feared, or after an operation for web- finger. FIG. 48. 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, i, 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, loth, nth, 12th, etc., courses make the reverse to each turn, so as to accommodate the obli- quity of the thumb, and thus prevent the bandage slipping off. At last ex- haust 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 dis- location, of the phalanges ; and also for confining dressings to any part of the hand and wrist. If the fingers should each, separately, demand compression, then the Spiral of All the Fingers (The Gauntlet) should be employed. Spiral of the Fingers and the Hand. 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. MANUAL OF BANDAGING. 63 Uses. — In the simpler injuries about the hand where the more complex bandages are hardly called for. FIGUEE OF 8 EXTENSOE OF THE HAND UPON THE FOEEAEM. 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 PIG. 49. the hand, i, conduct both heads to the palm, cross them, one above the other, and remount to the back, crossing them there, 2 2, and conduct them to the palm again. Re-crossing them, carry the heads upwards across the arm, 3, 3, to a point above the olecranon process, the hand being sufficiently ex- tended ; 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 exhaust both heads by Figure of 8 Extensor of the Hand upon the circular turns above the elbow, Forearm. Confining as usual. 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. FIGUEE OF 8 FLEXOE OF THE HAND UPON THE FOEEAEM. Description. — This bandage should be six yards in length by one and a half inches in width, and rolled into two equal heads. 64 BANDAGES OF THE UPPER EXTREMITY. 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 i 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. CAEPO-OLECEANON CEAVAT. Description." — I. Two cravats, each eighteen inches in length. II. A third cravat, thirty-six inches in length. FIG. 50. 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. Uses. — Same as the Figure of 8 Extensor. As these cravats are easier applied, and full as safe as the roller bandage, they are to be recommended 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 cravat, c, down the a?iterior surface of the member. This Carpo-Olecranon Cravat. MANUAL OF BANDAGING. 65 bandage would then take the place of the Figure of 8 Flexor of the Hand upon the Forearm, just described. SIMPLE SPIRAL OF THE FOREAEM. 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 confine by a circular turn above it ; exhaust the bandage by encircling the arm with spiraliform turns, as you see in the upper courses of the bandage depicted upon page 62. 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 a half inches in width. Application. — See figure 10, page 22. 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 return of venous blood to the vena cava superior. When employed, the surgeon should guard himself that he does not allow unequal pressure at any of the courses of the bandage. Should he have one part of the member more tightly constricted than another, he will only increase the mis- chief 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 67). 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. 66 BANDAGES OF THE UPPER EXTREMITY. Anterior Figure of 8 of the Elbow. Application. — Suppose it to be the right arm to be bandaged. FIG. 51. Place the initial end of the bandage, i, above the bend of the elbow, and confine by a single circular turn, 2. Continue on in the same direction till you get to the outside 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 circu- lar 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 ; whilst turn 6 is in course ot turn 3 ; 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 Posterior Fig- ure of 8 of the Elbow. 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 var- ieties. But these are so readily applied that no further description is necessary. CERVICO-ULNAE CEAVAT AND TRIANGLE. Description. — I. There should be a cravat two feet in length. MANUAL OF BANDAGING. 67 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 FIG. 52. 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 triangle into the cravat of the neck, as at c. Uses.- — In cases of bums of the back part of the elbow or transverse 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, or may not, be applied over the clothing. Cervico-Ulnar Cravat and Triangle. SPIEAL OF THE AKM. 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 65, except that you begin at the elbow. Uses. — To confine dressings to the arm-regions, or for the sup- port of the edges of longitudinal wounds, thus securing coaptation. It may or may not be applied with " reverses "; yet, should the biceps be well developed, it would be best to employ 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 a following page. 68 BANDAGES OF THE UPPER EXTREMITY. FOUE-TAILED BANDAGE OF THE SHOULDEE. 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 extremities to within four or five inches of this point, thus shaping it something like the " sling compress," figure 4, page 17. Application. — Place the plane of the bandage over the diseased shoulder, and carry the two superior ends of the bandage 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 furnishes a very handy, though not very firm variety of dressing. FIG. 53. LARGE OBLIQUE TEIAKGLE OF THE ARM A.^T> 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 triangle, A, at the hand, and carry one end backwards under the axilla of the diseased member to bring forwards, across the back, to the opposite shoulder, there to tie with its fellow, b, that ascends directly upwards across the front part of the chest to the same side. The apex of the triangle, c, is then to be brought forward and pinned, as you see in the wood-cut. Large Oblique Triangle of the Ann and the Chest. MANUAL OF BANDAGING. 69 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 clothmg. TEIANGULAR FEONT OF THE FOEEAEM. (TAe Ordinary Arm-Sling.) Description. — This should be a triangle having a base of forty-eight inches, and a height of twenty inches. The laity usually make it from a large shawl folded to a wdde cravat. Application. — Having flexed the forearm upon the arm, fold it FIG. 54. to the chest, and place the middle of the base of the triangle at the hand, a, and conduct the extremities 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 bandage fit easily, and yet furnish efti- cient support. Uses. — This, in some measure, takes the place of the preceding, yet does not Triangular Front of the Forearm. ^ ,, , . ^ fully supplant it. Is used more as a support of the hand, or lower part of the forearm. This bandage may, or may not, be applied over the naked bod}^ SMALL FEONT OF THE HAND OE FOEEAEM. (Small Sling of the Hand or Forearm.) Description. — A rectangular piece of cloth, eighteen inches long by nine inches wide. 10 70 BANDAGES OF THE UPPER EXTREMITY. FIG. 55. Small Front of the Haud or Fore- arm. Application. — Flex the forearm at right angles to the arm, and fold to the chest. Place the middle of the bandage beneath the hand and forearm, carrying both ends upwards and pinning them to the clothing on the breast. Uses. — As a support ot the hand or forearm in cases of minor injuries. POSTEEIOR DOUBLE FIGUl^E 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 holding FIG. 56. the bandage with its centre across the palm of the hand, place the centre of the cravat over the elbow, A, of the injured member, both ends hanging down towards the floor. Seize the innermost extremity 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 entrusting it to the care of an assistant. Carry the Posterior Double Figure of 8 of the Elbow and the Opposite Axilla. MANUAL OF BANDAOINO. 71 other extremity of the cravat forwards across the bend of the elbow, and over the other end of the bandage, then backwards, under the diseased axilla, as c, and then finally upwards to the opposite shoulder, there confining by tying, after the arm has been sufficiently extended backwards. You will then need a " sling," for the hori- zontal support of the forearm and hand, which can be pinned to the cravat as it crosses the shoulder, or about the neck. 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 anatomical reasons, to be superior to theirs for maintaining a coaptation of the clavicular extremities. It .certainly has the argument of simplicity in its favor. 72 BANDAGES Of THE B0D7. CHAPTER VIII. BANDAGES OF THE BODY. SPIEAL 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 ob- FiG, 57. liquely down across the chest from the top of 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 pin- ning, as at 10. Carry, now, the free end of the band- age, II, which you let fall Spiral of the Chest. ^^ ^j^^ beginning of the ap- plication, obliquely up over the chest to the opposite shoulder from whence dropped, and confine, by pinning, to the posterior spiral turns. Uses. — This bandage is employed where compression about the chest is needed, as in cases of fractures of the ribs, sternum or vertebra, 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 compressing the walls of the chest, if they be much expanded. MANUAL OF BANDAGING. 73 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 applicable where abdominal compression is de- sired, as after paracentesis abdominis, eviscerating wounds, drop- sies, ovarian tumors, etc. CIKCULAE-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 encircle, one or more times, the body, and may or may not be of several thick- nesses. II. A triangle having a base one yard in length, and a height of eighteen inches. Application. — Encircle the body with the quadrilateral portion FIG. 58. of the bandage, as a, and confine by pins or stitches. This done, place the 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 quadrilateral, or thoracico - encircling por- tion. Then carry the apex of the triangle down the back, and pin it to the quadrilateral portion ot the bandage at the back, so as to prevent it slipping down. Circular-Quadrilateral of the Chest, and Dorsal Cervico-Sternal Triangle. 74 BANDAGES OF THE BODY. 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 band- age, A, or by dropping it farther down the body, so as to encircle the abdomen, we get the Circular- Qiiadrilateral of the Abdomen, and the Dorsal Cervico-Sternal Triangle; or, if the bandage be wide enough to cover both the thoracic and abdominal regions, the Circular- Quad- rilateral of the Abdomen and Thorax, and the Dorsal Cervico-Sternal Triangle. In either of the cases two strips should be passed from the anterior surface of the quadrilateral to its posterior surface, across the perinseum, thus preventing the bandage from slipping upwards. The 7ises of these bandages are to furnish support to the ab- domen, as well as the thorax, after ovariotomy, paracentesis abdo- minis, 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 the triangle, a, at the inferior Fi"- 59. and middle portion of the chest. Carry the two ends, b, b, hori- zontally about the body, and tie at the back. Then carry the apex of the triangle, c, up across the chest, over the shoulder dis- eased, and then down to the ends tied at the back, where it is to be confined. Uses. — To retain dressings Anterior Thoracico-Scapular Triangle. vi t .•, ^ ^ upon either of the lateral-anterior 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 MANUAL OF BANDAGING. 75. 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. Application. — Place the initial end of the bandage at the side FIG. 60. of the neck, i ; confine by a single horizontal circular turn, 2. Continue the course of the band- age 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 Figure of 8 of the Neck and Axilla. , , , • up over the anterior sur- face 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 horizontal turn about the neck, and confine as usual. Uses.— To confine dressings to the clavicular, sub-clavicular, 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 76 SAND A GES OF THE BODY. 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. FIGUKE 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 FIG. 61. right arm (supposing it to be the right shoulder that you wish to cover) and confine it by two hor- izontal circular turns, 2 and 3, about the arm. Turn 4 make by mounting up to tne right side of the neck (from the back) and passing diagonal- Figure of S of the Shoulder and Opposite Axilla. ^^ downwards acrOSS the chest to the left axilla. Passing under this 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 confine by pinning. Uses. — Is used to maintain dressings upon the shoulder, or acromio-clavicular region, arm-pit, or axilla. Variety. — The Ascending Spica of she 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 MANUAL OF BANDAGING. 77 shown in the cut ; in other words, you ascend gradually upwards to the neck. The descending variety is preferable, as it gives greater solidity. SIMPLE BIAXILLAKY CRAVAT. Description. — This should be a cravat (a triangle folded to this form) one yard in length. Application. — Place the middle of the cravat in front of the FIG. 62. axilla of the diseased side, as a ; carry both extremities upwards over the same shoul- der as B, b', there crossing them. Then conduct the extremi- ty that passes over the front of the axilla, B, backwards over the shoulder and back, to the opposite axilla, and tie to the other extremity, b', that has been passed somewhat obliquely across the breast, as at c. Afterwards 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 poste- rior, or scapular, regions where vicious cicatrization may be feared. Simple Biaxillary Cravat. COMPOUND BIAXILLARY CRAVAT. Description. — -This bandage is made from two cravats, each being one yard in length, and made similarly to the Simple Bi- axillary. Application. — Placing one of the cravats, the centre, beneath 11 78 BANDAGES OF THE BODY. FIG. 63. one axilla, the right, for in- stance, conduct the two ends upwards and tie at the shoulder, as a. Place, now, the other cravat, beneath the opposite axilla, carry one extremity forwards, obliquely upwards across the chest, and the other obliquely up- wards across the back, to the opposite shoulder, pas- sing one end through the noose made by the cravat, a, first applied, and confine by tying, as at b. , Uses. — Similar to the above. It also affords means for confin- ing dressings to both axillary regions simultaneously. Compound Biaxillary Cravat. CEOSS 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, i, below FIG. 64. the diseased gland, the left for example, and confine by a hori- zontal circular turn about the body, 2. Continue on around the body till you come to a point below the diseased mam- ma, when you ascend obliquely across the chest to the opposite shoulder (the right in this case) thus finishing course 3. Course 4 is a horizontal circular turn about the body, in line of courses i and 2 ; whilst course 5 is similar to that of course 3. Continue on in the same man- ner till the bandage is exhaust- ed,^when you confine it by pinning, as usual. Cross of One Mamma. MANUAL OF BANDAGING. 79 UseS.^As a "sling," or support for an inflamed breast; and also for exercising a compression upon the gland, when occassion may demand it. 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 FIG. 65. cartilage, carry one end oblique- ly 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 diseased side, and confined to the extrem- ities of the triangle, at the back. Triangle of the Mamma. Uses. — Similar to the preced- ing; 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 eight inches in width when folded at the centre. Cut then the folded comers a and b off 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 o, and the two at h, stitch a narrow strip suffi- ciently long to meet and tie, with its fellow, (the two inferior) about the body, and (the two superior) about the neck. 80 :B AND AGES Of THE SODY. Application. — Introduce the diseased gland into the bourse a, FIG. 67. carry the two ends, B and b', around the neck, the one on one side, and the other upon the other, and confine them by tying. Conduct, now, the two inferior ends, c and c', hori- zontally 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 tiaccidit)- of the thoracic walls, or disease. Also useful in confining cataplasmata, or other dressings. Bourse of Tlie Mamma. CROSS OF THE TWO MAMMiE. 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 FIG. 68 extremity of the xiphoid cartilage and the umbilicus, and, going from right to left, confine it by a single horizontal turn, 2. Continue on in the same course, till you come to the right side of the chest when you mount obliquely up- wards across the chest to the left shoulder, thus finishing course 3. Course 4 is a horizontal turn about the chest. Continue on 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 finishing course 5. Course 6 is made similarly to course 3 ; course Cross of the Two Mammae. MANUAL OP BANDAGING. 81 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 roller is exhausted, when you confine as usual. Uses. — In case of disease of both breasts where suspension is required ; also for compression, and for retaining of dressings. It is not a very stable bandage, besides being open to the objection of cording the neck somewhat. For retaining topical dressings, or for suspension, the triangular mammary caps, see figure 65, would be preferable. Note. — Mayor's system may be used in making this bimammary bandage by simply applying the Triangular Caps of the Mammae, one to each gland ; the two apices being confined as described upon page 79, or else tied or pinned together. This would then be known as The Biviammary Triangle. Two Bourses may also be employed ; each being made and applied similarly to that one described upon pages 79 and 80. FIG. 96. POSTEEIOE FIGUKE OF 8 OF THE SHOULDEKS. (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. Application. — Place the initial end, i, at the middle and posterior part of the left arm. Confine it by two circular turns about the arm, 2 and 3. Continue on in the same course till you reach the anterior surface of the arm, when you as- cend obliquely across the axilla and 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 Posterior Figure of 8 of the Stioulders. 82 BANDAGES OF THE BODY. 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 backward in case of burns of the chest, or 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 consider- able cotton-wool, or some like substance, in the axillae, in order to guard against chafing of the parts. SIMPLE DORSAL BIAXILLARY CEAVAT. 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 FIG. 70. clavicular space, a. Carry 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. Uses. — This bandage of Mayor Simple Dorsal Biaxillary Cravat. ^^^^^ ^^^ ^^^^^ ^^ ^j^^ preceding, and may be preferred to it for its simplicity. COMPOUND DORSAL BIAXILLARY CRAVAT. Description, — L A cravat one yard in length. IL Another cravat two feet in length. MANUAL OF BANDAGING. 83 Compound Dorsal Biaxillary Cravat. Application. — Tie the shortest cravat about one of the shoul- FiG. 71. ders, the left for example, as at a. Now place the center 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 beneath the same axilla, to the back. Carry, now, the superior extremity through the noose form- ed by the cravat first applied ; then twist the other extremity about this one, as at b and c, and finally tie, as at d. Uses. — The same as the Simple Dorsal Biaxillary 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 mischance. ANTERIOE FIGURE OF 8 OF THE SHOULDERS. (Anterior '■'■ Star^^ Bandage.^ Description. — This bandage should be eight yards in length by two inches in width. Application.— Place the initial end, i, at the front of the 84 BANDAGES OF THE BODY. Anterior Figure of 8 of the Shoulders. PIG. 72. middle of the right arm, and confine by two horizontal circular turns, 2 and 3. Con- tinue on in the same course, till you reach the posterior surface of the arm, when you mount up over the shoulder of the same side and cross diago- nally downwards to the left axilla, thus finish- ing course 4. Pass the roller-head beneath this axilla, and 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 diago- nally 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 stitching. Uses. — ^In cases of fractures of the sternum, or separation of the sternal cartilages ; also in cases of bums on the interscapular 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 BIAXILLARY CRAVAT. Description. — This bandage is made from a cravat one and one-half yards in length. Application. — The opposite to that of the Dorsal Cravat, described upon page 82, this one being appHed across the chest. Uses. — Similar to those for which the preceding is employed. MANUAL OF BANDAGING. 85 COMPOUND STERNAL BIAXILARY CRAVAT. Description. — Two cravats, one one yard m length, the other two feet in length. Application. — Opposite to that of the Compound Dorsal Biaxillary Cravat, described upon page 83. 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 two- feet ones about each shoulder, tie the remaining one into the nooses formed by the other two, across the front of the chest. A fourth cravat is now necessary to prevent those fastened about the shoulders from slipping forwards and off these parts, and is tied to them across the back. 12 86 BANDAGES OF THE LOWER EXTREMITY. CHAPTER IX. 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 54, tigure 39. that no further discussion is necessary. Uses. — For injuries of the toes, similar to those of the fingers 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 I'humb and Wrist, or Spica of the Thumb. See figure 40, page 55. Uses. — Of a similar use to that of the Spica of the Thumb. DOUBLE T OF THE TOES AND ANKLE. Description, Application and Uses are so similar to the Double T of the Back of the Hand and Wrist, that a reference to it, figures 42 and 43, pages 57 and 58, will be sufiicient for its application to the foot. SPIRAL OF ALL THE TOES. (Gauntlet oj the Foot.) Description, — This bandage should be ten yards in length by three-quarters of an inch in width. MANUAL OF BANDAGING. 37 Application. — Similar to the Gauntlet of the Hand. See figure 47, page 6i. Uses. — Similar to those of the Spiral of All the Fingers, just referred to, only in case 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-quarter inches in width. Application. — Place the initial end, i, at the front of the leg, FIG. 73. a few fingers' breadth above the ankle, and confine it by the horizontal circular turn, 2. Continue on in the same course till you come to the inner malleolus again, supposing 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 malleolus, thus completing course 5. Course 6 is made similarly to course 3, course 7 to course 5, and so on. 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 com pression, 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 Spiral of the Inferior Extremi- ty, and will be sufficiently described when we come to treat of that dressing. Figure of 8 of the Foot and Ankle. 8S BANDAGES OF THE LOWER EXTREMITY. TRIANGLE OF THE FOOT. Description. — A triangle vaXh a base two feet in length and a height of ten inches. Application. — Place the base of the triangle obhquely across FIG. 74. the front of the ankle, a, and carry the superior end, b, around the lower part of the leg, and confine. Conduct the in- ferior extremity about the metatarso- phalangeal 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 adjacent, or to the calcanean region, or the lower part of the leg. Triangle of the Foot. FOUE-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 (figure 4). Application. — Place the centre of the bandage at the instep, 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. FOUE-TAILED BANDAGE OF THE HEEL. (Sling of the Heel.) Description. — This should be eighteen inches in length and four or more in width, and torn to a four-tailed bandage. Application. — Place the body of the bandage at the heel and MANUAL OF BAKDAGIKG. 89 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 '■'■ stockingr Is used as a retainer of cataplasmata to the toes or foot. POSTERIOR FIGURE OF 8 OF THE KNEE, Description. — ^The roller should be four yards in length by one and three-quarter inches in width. FIG. 75. Application. — Placing the initial end of the bandage, i, at a point somewhat above the popliteal space, confine it by a horizontal turn of the bandage, 2. Con- tinue on in the same direction, passing over the front of the thigh, till you come nearly to the posterior surface again, where you descend, obliquely, 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 pop- liteal 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 bandage, 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. 90 BANDAGES OF THE LOWER EXTREMITY FIG. 76. 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 horizontally forwards about the thigh ; cross them, and descend obliquely across the space, B, b', crossing one above the other there ; carry them now horizontally forwards about the upper portion of the leg, crossing them below the patella, to conduct them to the posterior surface of the leg, confining by tying, as at c. Uses. — This bandage fulfils the same in- dications as the above. The Popliteal Cravat. ANTEEIOE FIGURE OF 8 OF THE KNEE. Description. — A roller, four yards in length by one and three- quarter inches in width. Application. — Essentially the same as that of the Posterior Figure of 8 described upon page 89, 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 eftusion into the joint, and 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 76, page 90, above the patella, and carry the two extremities back- wards 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 courses of the bandage are made similarly to the corresponding 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 confining loose dressings thereon. MANUAL OF BANDAGING. 91 TESTUDO OF THE KNEE. (Roller Cap of the Knee.) FIG. 77. Description. — A roller eight feet in length by one and three- quarter inches in width. Application. — -Place the initial end of the bandage, i, below the patella, and confine by a single circu- lar turn, 2. Continue on in the same course with the bandage, making an as- cending spiral course for turn 3. The rol- ler-head is now carried upwards across the popliteal space, above the femuric condyles, and made to take the descend- ing spiral course 4, to finish this turn of the bandage. It is then carried down- wards across the popliteal space, so as to be in readiness to make the ascending spiral course 5. Course 6 is made simi- larly 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 exercise 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 Extremity 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 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. Testudo of the Knee. 92 BANDAGES OF THE LOWER EXTREMITY. 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 frac- tured, or, with the aid of compresses, to exercise compression, in cases of chronic synovitis. Four-tailed Bandage of the Knee. 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 band- age. 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, or for retaining dressings thereon. Is not a very stable bandage should the musculi gastrocnemius et soleus be well developed. Variety. — This bandage may be applied to the thigh ; it then becomes T/ie Simple Spiral of the Thigh. The starting point, in this case, being at the knee. MANUAL OF BANDAGING. 93 KEVERSED 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 Extremity, and will be sufficiently described when treating of that bandage. See figure on page 96. 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 7//e Reversed Spiral of the J high. THE FIGURE OF 8 SPIRAL OF THE EXTREMITIES. Description.- -This bandage is a //(S//^^/^ spiral, and needs for its application a roller bandage ten yards in length by two inches in width. Application.- Place the initial end at the roots of the toes, confining by a single spiral turn about the foot, and cover the foot as in the Spiral of the Inferior Extremity, by rever- ses and figures-of-8. Having reached the leg, one turn and a half is made before a reverse is used. Thus the reverse is employed on the second turn of an ordi- nary spiral instead of upon the first, as in the simple spiral 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 1 1 is com- pleted as an upward spiral about the limb, «vith no reverse, whilst 13 The Figure of 8 Spiral of the Extremities. 94 BANDAGES OF THE LOWER EXTREMITY course 12 would be a reversed spiral, coming from above doAvn- wards, across the front of the limb. Course 13 is similar to course II ; course 14, to course 12, and so on until the bandage is exhaust- ed. This makes, then, a Figure of 8 Spiral of the Extremities with alternate reverses. Uses. — Similar to those for which the Simple and the Reversed 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 plaster- 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 mate- FiG. 80 rial, as very thinly woven flannel, so as to be easily "moulded to a part," it may be made throughout luithout a single rei'erse. Each course of the 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 upivard spiral, turn i o, a downward spiral turn II, an upward spiral again, overlap- ping turn 9 ; turn 12, a downward spiral, overlapping turn 10, and so on until the limb is sufficiently encompassed. This also makes quite a firm dressing, 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 2,?, iht Figure of 8 Batidage of the Extremities^ and can be applied, as its name indicates, to either the inferior or superior, extremities. Figure of 8 Bandage of the Extremities. MANUAL OF BANDAGING. 95 FIG. 81. 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, obhquely across the front of the leg, and carry the superior extremity around below the patella, and confine with a pin, b. Then conduct the inferior extremity around the lower part of the leg, and also confine 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 maintaining compression, when this may be required. Variety. — This bandage may be ap- Triangle of the Leg. ^^-^^ ^^ ^^^ p^^.^ ^^ ^^^ j^^^ ^^ ^^^^ ^^ ^^^ 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 sufiiciently 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 compress (figure 4), upon page 17. 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 inferior ends are then to be conducted about the lower portion ot the leg, and also confined by tying, Uses. — To confine cataplasmata, or other dressings, upon the gastrocnemial and soleal region, 96 BANDAGES OF THE LOWER EXTREMITY. EEVERSED SPIRAL OF THE INFEEIOR 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 metatarso-phalangeal articulation, and confine 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 73, page 87. It is also often necessary 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 covered in by The Testudo, figure 77, page 91, or the simple spiral turns, 3t, 32, ?,?>, 34 and 35 in the cut. Having cleared the femuric condyles, you then make spiral reverses to the hip, where you confine the bandage in the usual way. Uses. — ^For all the multitudinous purposes such an injured 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 65. Keversed Spiral of the Inferior Extremity. RECURRENT FOR AMPUTATED THIGH. Description. — This bandage should be twelve yards in length by one and three-quarter inches in width. MANUAL OF BANDAGING. 97 Application.- FIG. 83. -Place the initial end, i, upon the front of the thigh, and confine by three horizontal circular turns, and 4. Continue the Recurrent for Amputated Thigh. course of the bandage about the limb, horizontally, finishing turn 5 at the lateral border of the member. Reverse the bandage at ri^/ii angles, and continue course 6 down the limb, across the stump, then up to the fourth course of the bandage, thus finishing turn. 6. Re- verse, now, the bandage at right angles 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 band- age 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 bandages 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; 2 he Recur- rent for an Amputated Forearm ; The Recurrent 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 objec- tion holds good against these bandages, as the one just described ; viz.: rather more ornate than useful. 98 BANDAGES OF THE LOWER EXTREMITY. TKI ANGLE FOE 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, Fio- 84. upon the anterior surface of the thigh, at a proper distance from the cut sur- face ; carry the two extremities back- wards about the member, and 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 in- jury from clothing and the like, and also for confining cataplasmata. Variety. — -By varying the size of the triangle, it can be made to answer for 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. Triangle for Thigh Stmiip. MALTESE-CEOSS FOE THIGH STUMP. Description. — I. A piece of lint, or cloth, sixteen inches square, cut to the form of a Maltese cross, see figure 7, page 20. II. A roller two yards in length, by two inches in width. FIG. 85. 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 pos- sible. Then confine with the roller by the use of circular turns about the limb, using reverses, if need be. Uses. — Similar to the Stump-triangle, Maltese-cross for Thigh Stump, ^^^j equally useful and easy of application. MANUAL OF BANDAGING. 99 Variety. — By varying the size of the cross, and the roller, this bandage is equally applicable for any stump of either extremity. It makes most an excellent dressing for hip or shoulder-joint stumps. It would then be TAe Maltese-cross for Leg Stumps The Maltese-cross for Arm Stump., etc., according to the uses for which it is employed. CAPUTINA. (Rosette Stump Dressing.) Description. — Take from nine to fifteen strips of cloth (according 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. 86. These strips are to be placed in two groups. One set should be so arranged as to form a half rosette, a, whilst the others should be ar- ranged in a parallel group, B, each strip slightly overlap- ping its fellow. The half- rosette, including one strip parallel with the second set, is made secure with a pin, or stitches, at the point of radi- ation of the different pieces, called its center, as a. The horizontal strips of parallels may now be stitched 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), Diagram of the Caputina. 100 BANDAGES OF THE LOWER EXTREMITY. 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 FIG- 87. bandage. The centre, a, figure 86, is placed opposite the median line of the under surface of the stump, at a point some six inches from its end, and con- fined there by the long cross strip, c- c, which encircles the member. The remaining portions of the rosette are thenla id, smoothly and successively, over the stump, covering the end com- pletely. The bandage is then finished by passing the horizontal parallel strips, B, over the remaining portion of the limb, securing the free ends of the ro- sette that are folded over its anterior surface, thus completing the dressing which is represented, as applied to a thigh-stump, in figure 87. 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 extension of the principle of that of Scultet's, the whole upper portion, b, figure 86, being but the bandage ofScultet. Uses. — This bandage is used only in the dressing of stumps; and it is particularly valuable where pressure is recjuired, — as when the flaps retract, making the wound gape, and thus leaving the bone exposed. In its application the stump needs be lifted but once, i. c, when the bandage, lying upon the paper, is first slipped under — a dcsideraiinn wanting in all other stump-dressings. C.aputina on, the previously applied roller, and end- ing 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 bot- tom, 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 removed, and reapplied. Variety. — See page no, upon the hii?es caoictchouc vidcanise, of Nelaton. The Capote is also made a legitimate use of in these cases. In both instances the roller, i, is to be applied before the rest of the dressing. The ring of the capote should rest upon the applied roller. MANUAL OF BANDAGING . 121 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 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, encroaching upon the gland, to and over the opposite shoulder, there ending ; you thus follow course 13 of the Cross of One Mamma figured upon pa.ge 78. The other strips should be applied in a similar manner, only en- croaching upon the gland more and more, until the necessary sup- port has been given. If compression is desired, cross strips can be run diagonally down- wards across the chest, from over the shoulder of the diseased side to the hepatic region. An American surgeon has taken advantage of the expansibility of sponge in maintaining compression of the mamma. The sponge (a large one) is thoroughly cleansed and impregnated with some antiseptic, and then pressed between two flat surfaces until it be- comes 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. Uses. — As a support of an inflamed or hypertrophied breast. Also, when compression is used, as a therapeutic agent in the treat- ment of any of the various forms of abscess that may arise within or about the gland. FOR EXTENSION OF THE LEG. Description. — Two broad and somewhat tapering adhesive strips, of a length sufficient to reach from the knee-pan to below the foot and tie. II. Several narrow strips of the same material to surround the limb when the extension strips are applied. 122 STRAPPINGS. Application. — The broad strip, a-b, is warmed and applied to FIG. 107. the side of the leg, while its fellow is made to do similar service upon the other side of the member. The narrow adhesive strips, c and D, are then applied spirally about the leg, as confiners. 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 attached. Uses. — In cases of fracture where extension is demanded. Also, in chronic arthritis, and for overcoming vicious contractions. Variety. — This dressing may be applied to the upper extremity, though an occasion rarely calls for its use there. For Extension of the Leg MANUAL OF BANDAGING. 123 CHAPTER XI I. KNOTS. Ligatures were introduced to the profession by Ambroise Pare. Previous to his time the " actual cautery," or the cautery of boiHng oil, was made use of for arresting haemorrhage. Ligatures are con- fined 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 SUEGEON'S KNOT. Description. — This is formed by passing 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 common 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 EEEF KNOT. Description. — This is the ligature knot in general use among surgeons for arresting haemorrhage. FIG- 108. A " Granny " knot, b, is quite frequently made for the Reef, a, through inattentiveness of the surgeon ; and students almost in- variably 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 Reef and "Granny" Knots. The Reef knot, A, is made by first crossing the ends of the ligature so that the one held by the right hand shall be uppermost. You then pass the right extremity 124 KNOTS. around that held in the left hand, from within outwards ; this makes the first knot, which is pressed firmly down to, and drawn con- strictingly 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 con- signed 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 vessel. 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 purpose of protecting the limb from excoriation, and of preventing the slipping of the knot from off the extremity when making traction. FIG. 109. Application. — Place one of the extremities of the towel, or cravat, over the back of the forearm, for example, as at i ; pass now the other extremity down across the arm, and up over (diagonally from below upwards) the one first applied, as at 2. Ascend the arm a little space, and then make another horizontal turn about it, bringing the end up under the course 2, thus finishing course 3. Uses. — For extension of a member during ciove-wtch Knot. reduction of a dislocation. More especially applied to the superior extremity. MANUAL OF BANDAGING. 125 M. GEEDY'S EXTENSION KNOT. Description. — This knot is executed with a cravat one and one-half yards in length ; the length, however, varying, according to the purposes for which it is employed. Application. — Place the centre of the cravat upon the tendo FIG. 110. Achillis, just above the ankle joint, having the dorsal surface of the foot towards you; then bring the two extremities of the cravat forwards, crossing them upon the front of the tibio-tarsal articulation, i'; 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 courses 2, 2', beneath the crossed extremities, 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. Uses. — For extension of the lower extremity, as in dressing fractures ; the counter-extension being made by the perinseal band, or inclination of the bed. M. Gerdy's Extension Knot. 17 126 CAIAPLASMATA. CHAPTER XIII. UPON CATAPLASMATA. CATAPLASMA CAKBONIS—( C'AarcoaZ Poultice). Formula.* — Take of wood charcoal, in powder, one-half an ounce ; bread crumbs, two ounces ; linseed meal, one and one-half ounces ; boiling 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 char- coal, 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 Pharmacopceia. 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 boiUng, as the Phar- macopoeia recommends, the poultice, when spread, is generally of as sufficiently 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 accelerating slough- ing and the discharge of inflammatory products ; also that of pro- tecting 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 poultice under consideration. A charcoal poultice is, in fine, an antiseptic and disinfective poultice. The Pharmacopceia has recommended wood 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 gangrenous surfaces, by absorbing the gases. It must be frequently appUed, and should be used in all cases of gangrenous ulceration. *ISroTE. — The Formulae of most of these cataplasms are taken from the British Pharmacopceia. MANUAL OF BANDAGING. 127 CATAPLASM A CONII—( SemZoc^ 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, constantly 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). FoRMXJiiA. — 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 lA'El— {Linseed Meal Poultice). Formula. — Take of linseed meal, four ounces ; olive oil, one-half of a fluid-ounce ; boiling water, ten fluid-ounces. Mix the meal gradually with the water, constantly stirring it, and then gradually add the oil. Uses. — As a general emollient dressing. The Pharmacopczia recommends the incorporation of oil in the cataplasma, because it is understood that the " pressed " meal is to be used. If the un- pressed meal, which, perhaps is best, is employed, the oil is un- necessary. This poultice may be made anodyne, antiseptic or stimulating, just as the surgeon may fancy, by the addition of drugs producing these several effects. CATAPLASMA SINAPIS— (ilfMstord 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 Pharmacopaia has directed that boiling water be used. It would be better not to 128 CATAPLAS3fATA. employ water at so high a heat, as it deteriorates its rubefacient power in some varieties of mustard. The laity often make an addi- tion 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. CATAPLASM A SOBJE CB.LO'Rm AT JE~{Chlorine Poultice). Formula. — Take of solution of chlorinated soda, two fluid-ounces ; lin- seed 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 most an excellent dressing for foul and gangrenous ulcers. Carbolic, or, perhaps be'tter, Salicylic acid, is a useful adjuvant 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 important ingredient, in a certain class of eczematous cases. CATAPLASMA PANIS ET J.ACTlS—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. Uses. — As an antiseptic and absorptive dressing. The water may be charged with antiseptics or anodynes. MANUAL OF BANDAGING. 129 HOW TO SPEEAD A POULTICE. The batter of the poultice having been prepared, it is necessary to have a piece of thick cotton cloth, or linen, two or three inches wider than the surface you wish to cover with the cataplasma. 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 cataplasm, as well as effecting a sort of a confine- ment of the batter to the cloth. You now spread a very thin piece of muslin (the thinner the better) over the whole surface of the poultice ; 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 pressure, a severe throbbing pain will ensue. After the cataplasm has been properly placed, it, and a portion 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, the whole finally being lightly confined by a proper bandage. The oiled silk, or muslin, serves a double purpose ; that of confining the heat or moisture to the part, and of protecting the bed clothes, or clothing, from the water in the poultice-batter. ii^iDEx:, Arm-sling, ordinary, 69. Bandages in general, 19. • classification of, 24. regional classification of, 25. compound, 25. simple, 25. of the head, 26. of the neck, 47. of the upper extremity, 54. of the body, 72. of the lower extremity, 86. Binocle, 29. Boulette, 14. Bourdonnet, 14. Bavarian plaster splint, 112. Bonnet, triangular, of the head, 31. of the nates, 108. Bourse of the mamma, 79. of the scrotum, 110. Capote, 110, 120. Caputina, 99. Cataplasma carbonis, 126. conii, 127. fermenti, 127. lini, 127. suiapis, 127. sodse chlorinatse, 128. pauis et lactis, 128. how to spread a, 129. how to apply a, 129. Charpie, 13. Circular of the forehead and eyes, 26. of the neck, 47. Circular- quadrilateral of the chest, and dorsal cervico-stemal triangle, 73. of the abdomen, and the dorsal cer- vico-sternal triangle, 74. of the abdomen and thorax, and the dorsal cervico-sternal triangle, 74. Common plaster dressing, 114. Compresses, 16. button-hole, 17. circular, 16. complex, 17. graduated pyramidal, 16. graduated regular, 16. perforated, 17, rectangular, 16. sling, 17. square, 16. triangular, 16. of two heads, 17. of three heads, 17. of four heads, 17. of six heads, 17. Cotton-wool, 13. Cravat, cervical, 47. carpo-olecranon, 64. cervico-ulnar, and triangle, 66. of the neck and axilla, 75. simple biaxillary, 77. compound biaxillarj', 77. simple dorsal biaxillary, 82. compound dorsal biaxillary, 82. simple sternal biaxUlary, 84. compound sternal biaxillary, 85. popliteal, 90. of the knee, 90. tarso-patellar, 100. tarso-crural, 101. taiso-pelvic, 102. Gruro- pelvic, 106. inguinal, 106. sacro-bicrural, 106. perinaeal, 107. Cross, Maltese, 20. of the eye, 28. of the eyes, 29. simple, of the chin, 32. of the head, 34. of the head. Mayor's, 38. posterior, of the head and neck, 45. of the occiput, 45. of the mamma, 78. of the two mammae, 80. of the groin, 103. Emplastrum resiuae, 117. Fenestrated immovable dressings, 116. INDEX. 131 rigure-of-8, posterior, of the head and axillae, 47. anterior, of the head and axillse, 49. of the head and axilla, 52. posterior, of the hand and wrist, 55. anterior, of the hand and wrist, 56. extensor of the hand upon the fore- arm, 63. flexor of the hand upon the forearm, 63 anterior, of the elbow, 65. posterior, of the elbow, 66. posterior, double, of the elbow and op- posite axilla, 70. of the neck and axilla, 75. of the shoulder and the opposite axilla, 76. posterior, of the shoulders, 81. anterior, of the shoulders, 83. of one toe, 86. of the foot and ankle, 87. posterior, of the knee, 89. anterior, of the knee, 9i). spiral, of the extremities, 93. bandage, of the extremities, 94. Fillet, or head-band, 27. Four-tailed bandage of the chin, 33. of the head and neck, 46. of the hand, 57. of the elbow, 66. of the shoulder, 68. of the instep, 88. of the heel, 88. of the leg, 95. of the knee, 92. of the hip, 108. Front, triangular, of the forearm, 69. small, of the hand or forearm, 69. Gateau, 13. Gauntlet, of the hand, 61. of the foot, 86. Handkerchief bandage, 41. Harelip bandage, 48. Head-band, 27. Mayor's, 30. Immovable dressings, 112. Invaginated roller, of the upper lip, 43. of the under lip, 44. Invaginated triangle, of the upper lip, 45. of the under Up, 45. Knot, surgeon's, 123. reef, 123. " granny," 123. clove-hitch, 124. M. Gerdy's extension, 125. Knots, 123. Knotted bandage^of the head, 36. Lateral bandage of the neck, 52. Maltese cross, 20. for thigh stump, 98. for leg stump, 99. for arm stump, 99. Monocle, 28. Parrafin bandage, 116. Peiete, 14. Plaster, adhesive, 117. bandage, Pirogofifs, 114. Plumasseau, 13. Posterior " star " bandage, 81. Poultice, charcoal, 126. hemlock, 127. yeast, 127. linseed meal, 127. mustard, 127. chlorine, 128. bread-and-milk, 128. oakum, 128. how to spread a, 129. how to apply a, 129. Recurrent bandage, of the head, .39. for amputated thigh, 97. for amputated leg, 97. for amputated forearm, 97. for amputated arm, 97. Reverses, how to make, 22. RoUer, a, 20. how to make, 21. how to apply, 22. how to confine, 23. of the chin, 32. invaginated, of the upper lip, 43. of the under lip, 44. of the superior extremity, 65. cap of the knee, 91. Rosette stump dressing, 99. Sheath, of the fingers, 62. of the foot, 80. Silica bandage, 116. Six-tailed bandage of the head, 40. Skull-cap, 26. Sling, of the face, 27. of the chin, 33. of the head, 40. of the occiput, 66. of the hand, 57. large, triangular, of the arm, 68. small, of the hand or forearm, 69. of the instep, 89. of the heel, 88. for the superior extremity, 103. Spica, of the shoulder, 75. descending, of the shoulder, 76. ascending, of the shoulder, 76. of the toes, 86. 132 INDEX. ascending, of the groin, 103. descending, of the groin, 104. of the thumb, 55. Spiral, of the neclv, 47. of one finger, 54. of all the fingers, 61. of the fingers and the hand, 62. simple, of the forearm, 65. reversed, of the superior extremity, 65. of the arm, 67. of the chest, 72. of the abdomen, 73. of one toe, 86. of all the toes, 86. of the foot, 87. of the knee, 91. simple, of the leg, 92. of the thigh, 92. reversed, of the leg, 93. ofthethiph, 93. figure-of-8, of the extremities, 93. reversed, of the inferior extremity, 96. Starch, or plaster, roller, 115. Strappings, 117. for the foot and anlile, 118. for wounds, 119. for the testicle, 120. for the breast, 121. for extension of the leg, 122. Suspensory bandage of the scrotum, 109. T of the head and ear, 36. of the temple, 36. perforated, of the head and ear, 37. double, of the nose, 41. ofthe mouth, 42. double, posterior, of the head and thorax, 49. double, anterior, of the head and thorax, 50. double, of the bacli ofthe hand and wrist, 57. single, of the back of the hand and wrist, 58. perforated, of the hand and wrist, 59. double, anterior, of hand and wrist, 60. single, anterior, of hand and wrist, 60. double, ofthe toes and ankle, 86. trapezoidal, of the groin, 104. double, ofthe perineeum, 107. single, ofthe perinaeum, 107. double, of the trunk. 111. Tampon, 14. Temple bandage, 34. Tents, 14. Testudo of the knee, 91. Triangle, ofthe face, 29. ofthe eye, 29. fronto-oculo-occipital, 30. fron to-occipital, 31. occipito-frontal, 31. biparietal, .31. occipito-mental, .34. of the chin, 34. occipito-auricular, 38. ofthe head, 41. fronto-cervico-labial. 45. fronto-dorsal, 49. occipito-sternal, 51. parieto-axillary, and cravat, 52. lateral, ofthe neck, .52. carpo-digito-palmar, 59. carpo-digito-dorsal, 60. of the elbow, 66. large oblique, of the arm and chest, 68. anterior, thoracico-scapular, 74. posterior, thoracico-scapular, 74. ofthe mamma. 79. bimammary, 81. ofthe foot, 88. of the leg, 95. for thigh stump, 98. for leg stump, 98. for arm stump, 98. scapulo-tibial, and cravat, 102. crv(ro-inguinal, 105. cruro-pelvic, 105. ■ sacro-pubic, 108. coxo-pelvic, 108. lumbo-scrotal, 109. Tubes caoutchouc vulcanise, 110, 120. ADYEKTISEME^TS. SHEPARD & DUDLEY Importers, Manufacturers and Wholesale Dealers in MANUFACTURERS OF Elastic Goods. Supporters, Chest Protectors, Etc. iBstrnent Makers to the New Yorl Eye M Ear Inflrinary. 150 William Street, NEW YORK. Copy of the Judges' Report, in Department III, Group 5, Div. A, at the 43d Exhibition of the American Institute, held in the City of New York, October and November, 1874 : SURGICAL INSTRUMENTS AND APPLIANCES. SHEPARD & DUDLEY, 150 William Street, New York. We heartily concur in commending this case of Surgical Instruments and Appliances, as being decidedly valuable, excellent in manufacture, equal to the best of its class known, reflecting great credit on the exhibitors. A SILVER MEDAL AWARDED. Heney B. Sands, M. D., Prof, of Anatomy in the College of Physicians and Surgeons, Surgeon to Rosevelt an(J Bellevue Hospitals, New York. Edward D. Janewat, M. D., Lecturer on Materia Medica and Therapeutics, and Clinical Medicine, and Physician to Bellevue Hospital. T. P. GiBNEY, M. D.. Surgeon to the Hospital for Ruptured and Crippled, New York. sBiiasa'-^o»°''®^ Yon Braun's Starch Bandage Shears for Removing any Immovable Dressings. iF'ie.EiDEi^icic STEj^i^nsrs, AISTD IjVtFORXER, OF MEDIGM MERGHM\IDISE. DEPOT FOR AMERICAN DRUGS AND THEIR PRODOCTS, DETROIT, --- MICHIGAN. WAREHOUSE No. 89 ^WOODWARD AVENUE, Laboratory and Drug Mills, Woodbridge and Congress Sts,. bet. Fifth and Sixth, The following NEW DRUGS are ofiered, EXTRACT, ELIXIR, JABORANDI The new and intensely powerful sialo- gogue and sudorific. GRINDELIA The new Californian specific for Asthma and Bronchitis. BOLDO Leaves of a Chilian evergreen, used as an alterative in liver diseases, tonic in fevers. CHIONANTHUS A valuable tonic, aperient and altera tive in bilious and intermittent fevers. CAINCA Brazilian diuretic, for dropsy. C AST AN E A Sweet chestnut leaves, used in whoop- ing cough. FUCUS VESICULOSUS Used for reducing obesity. MALT (EXTRACT) Diastase, milk, malt-sugar and alkaline salts. Nutritious tonic. RICINUS, FOLIA Galactagogue, inducing the flow of mother's mUk when absent. SILPHIUM Compass plant, valuable tonic and alter- ative. Crude or Powdered, and in form of FLUID SYRUP or TINCTURE. DAMIANA The new aphrodisiac from Mexico, re- puted reliable for restoring virility. I GUARANA New South American drug, used in headache, neuralgia, dysentery, nervous depression, etc. CEREUS GRANDIFLORUS Flowers of the night blooming cereus, used in functional palpitation of the heart. (In fluid extract and tincture, only). CALENDULA Flowers — Anti-spasmodic. EUCALYPTUS Used in intermittents, and as an aroma- tic anti;eptic. G-UACO A Venezuela plant, reputed of value as a diaphoretic in cholera, yellow fever, etc. KAMALA AND KOUSSO Abyssinian anthelmintics, used for ex- pelling tape worm. CENOTHERA Evening primrose. Alterative in skin diseases. RHAMNUS FRANGULA Bark of black buckthorn, valuable ca- thartic and aperient. SUMBUL The Bucharian musk root, is a nervous anodyne in delirium, hysteria, gastric spasms, etc. Catalogue No 75, a comprehensive Priced list, 132 Pages, 168 Classes, comprising about 10» 000 Pharmaceutical products, will be sent to any address for 25 cents. Fluid Extracts, 420 kinds. Pills, Sugar Coated, 404 " EUxirs, 212 " Solid Extracts 670 " Pressed American Herbs etc. I kinds. Medicated Lozenges, 212 kinds. Resinous Substances, 220 " Suppositories, 121 kinds, 5 sizes. Powdered Drugs, 823 sorts. Miscellaneous Products, over 7,000 kinds. L. BLACK & CO., Manufacturing Opticians, 77 Woodward Avenue, DETROIT, MICH. Microscopes and Slides, Fever Thermometers, Artificial Eyes, Cataract Lenses, Magnifiers, Loupes, Opthalmascopes, Test Tubes, Philosophical Apparatus, Electric Batteries, etc., etc. Spectacles and Eyeglasses fitted and adjusted to the failing Eyesight. Orders by mail will receive prompt attention. lu. BLACIt &, OO. Established jL. JL). 1843. W. B. KEEI^, OOOKE & CO., PUBLISHERS, BOOKSELLERS AND STATIONERS, C EC I O -A. a- o. Medical and Surgical Publications. TO THE MEDICAL PROFEiSSION. W. B. KEEN, COOKE & CO.'S MEDICAL BOOK DEPARTMENT is the most extensive in the country. Particular attention is called to our catalogue of Medical Books which will be mailed Free on application. HOW TO PROCURE BOOKS.— We will forward per U. S. Mail and prepay postage upon the same, all books weighing four pounds and under (books weighing over four pounds are not mailable), upon receipt of Publishers' Prices, as named in our Catalogue. 4i®="'VVe assume no risk upon Money or Books, although out of the many hundreds of volumes sent by us by mail, none to our knowledge have been lost. We will forward Books to all points reached by the Regular Express Lines, east of the Mississippi River, and prepay charges on the same upon receipt of Publishers' Prices. Money to accompany all orders. 4®=- When Books are forwarded per Express " Collect on Delivery" all expenses of freight and of returning the money, must be paid by the consignee. CHICAGO MEDICAL JOURNAL AND EXAMINER. Editor : William H. Byford, A.M., M.D. Associate Editors : James H. Etheridtre M D Norman Bridge, M. D. Jas. Nevins Hyde, A. M., M. D. Ferd. C Hotz M d' ISSUED MONTHLY. )^" Jfostage Free to alt Subscribers in the United States. -®ft The CHICAGO MEDICAL JOURNAL AND EXAMINER will be sent for one'year to anv Subscriber m the United States, postage peepaid by the publishers, on the receipt of FOUR DOLLARS PER ANNUM IN ADVANCE. Making a Splendid Volume each year, at the low price of Four Dollars W. B. KEEN, COOKE & CO., Publishers, I 13 & 115 State St., CHICAGO. MEDICAL BOOKS, lo per cent, discount, LITERARY and GENERAL BOOKS, 20 per cent. Discount to the Medical Profession. Sign of the BOOK 189 Wood^'^ard Avenue, Detroit. J. M. ARNOLD & CO. Orders by IMail ^vill receive prompt attention. M-edical and. ]yiiscellaneovis Boobs mailed post-paid on receipt of retail price or by Express at th.e discounts above, charges being paid by Consignee. FARRAND, WILLIAMS & CO.'S COD LIYEE OIL Is put up in pint bottles, with our firm name on the labels and over each cork. The oil is imported from Norway in tin lined and perfectly air tight barrels. It is made with scientific care at a low temperature, in order to insure its paleness, sweetness, and free- dom from unpleasant ilavor. The delicacy and purity thus obtained, render it especially valuable to the invalid. A careful observation has convinced us that the oil yielded by the Codfish of the Norwegian Seas is preferable, in point of palatableness and medicinal properties, to the Oil of Newfoundland, and this opinion has been confirmed by the re- cent tendency of medical and popular selection. It contains less solid fats, or stearine, and is therefore digested bv delicate stomachs, which cannot tolerate the coarser Oils which are put upon the market. THE NORWEGIAN 00 D LIVER OIL Costs to import just double the price of Newfoundland Oil, yet we sell the former in bot- tles at as low price as the latter is sold for, and in doing so, we feel that we are confer- ring a boon upon the public. If the medical profession will designate our Oil in their prescriptions, it will give their patients satisfaction, and they can rest assured that the Oil is inferior to none. F^iE^i^-i^isriD, -v^ixjXjIj^i^^s &c 00., MANUFACTUREES OP MEDICINAL ELIXIRS. MEDICATED TINCTURES, SYRUPS, ESSENCES, WATERS, OINTMENTS, PLASTERS, All Warranted Officinal Strength. Dealers in and Importers of Pure Chemicals, Fine Powdered Drugs, Shaker's Herbs, Gums, Pure Essential Oils, Etc. (^"Purity and Quality are always of the First Consideration with us in buying and selling. COLUMBIA UNIVERSITY This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED ! DATE DUE ^ Mi; m WM 1 I ^"^»% V ^fClp,,,, j^ iVf> Q IQAi^ m ^^'' U si O »3"^« _ I ■ ^ ■ C28'638)M50 COLUMBIA UNIVERSITY LIBRARIES (hsi.stx) RD113L55C.1 A manual of bandaqinc 2002139944