Columbia Win^ttsiitp in tJeCitp of i^eU) pork College of S^i^y^idam anb burgeons; iHisssf (^n^^it €llis(on in mentor? of 3ir. Ctnegt Hilliam ^u^al X9X8 i THE ROLLER BANDAGE. BY WILLIAM BAETON HOPKINS, M.D., SURGEON TO THE OVT-PEPARTMENTS OF PENNSYLVANIA, EPISCOPAL, AND UNIVER- SITY HOSPITALS, ASSISTANT DEMONSTRATOR OF SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, ETC. WITH SEVENTY-THREE ILLUSTRATIONS. PHILADELPHIA: J. B. LIPPINCOTT & CO. 1883. Copyright, l«83, by J B. Liit'INcott & Co. PEEFAOE. The plan which has been adopted in this book, as will be seen at a glance, is to teach by nu- nierous illustrations rather than by elaborate description the method of applying the roller bandage. In order that the student may most readily familiarize himself with this very im- portant subject, a series of illustrations are presented which were made in the following manner : Each bandage was applied to a living model, and whenever the roller pursued a course which the author has found in his association with students was the cause of any uncertainty, it was at once photographed. From these pho- tographs accurate draw^ings were made by the artist, Mr. J. L. Wallace. In this way it is hoped that the intricate course traversed by the roller in the most complex dressing has been made sufficiently plain to enable the student to apply it for himself almost unaided by the text. The 4 PREFACE. latter will be found very brief and devoid of everything but the rule for application and the use to which the dressing is commonly put. A series of definitions and general rules for bandaging occupy the earlier pages of the book. W. B. H. CONTEETS. The Koller Bandage. Definition . Material Rolling By Hand By Key By Machine Size Uses . Tension Varieties Parts . Pack 9 9 10 10 10 12 12 13 13 17 17 Application. To Eix 18 To Repeat 18 To Overlap 19 To Recur 19 To Reverse , . . . . . . .19 To Reverse Descending . . . ' . . .21 To Secure 22 To Remove 2-\ 1* 5 CONTENTS, Special Bandages. A Circular Bandage . A Spiral Bandage An Oblique Bandage A Spica Bandage A Figure-of-Eight Bandage A Spiral Eeversed Bandage A Recurrent Bandage Bandages of the Head. Barton's Bandage Gibson's Bandage Occipito-facial Bandage Crossed Bandage of the Jaw Recurrent Bandage . Figure-of-Eight Bandage of one Eye Figure-of-Eight Bandage of both Ey Hunter's V Bandage . White's Head and Neck Bandage Knotted Bandage Bandages of the Upper Extejcmity. Desault's Bandage Velpeau's Bandage Figure-of-Eight Bandage of the Neck Spica Bandage of the Shoulder Ascending . Descending . Spiral Reverted Bandage of the Upper Extremity Figure-of-Eight Bandage of the Elbow . c and Axilla Page 23 28 23 24 24 24 24 27 30 31 33 34 36 37 38 39 40 42 51 54 55 55 58 60 62 CONTENTS. Pagk Spica Bandage of the Thumb ..... 63 Ascending 63 Descending 64 Gauntlet Bandage ....... 65 Demi Gauntlet Bandage .6(5 Bandages of the Trunk. Spiral Bandage of the Chest . . . . .67 Anterior Figure-of-Eight Bandage of the Chest . 68 Posterior Figure-of-Eight Bandage of the Chest . 70 Single Spica Bandage of the Breast . . . .71 Double Spica Bandage of the Breast . . . .73 Bandages of the Lower Extremity. Single Spica Bandage of the Groin . ... 70 Ascending Spica ....... 70 Descending Spica ...... 78 Double Spica Bandage of the Groin . . .80 Ascending Spica ...... 80 Descending Spica 82 Figure-of-Eight Bandage of the Knee . . .84 Spica Bandage of the Foot . . . . .85 Incomplete Bandage of the Foot . . . .87 Complete Bandage of the Foot . . . . .88 Spiral lieversed Bandage of the Lower Extremity . 90 THE ROLLER BANDAGE. Definition. — The term roller bandage is gener- ally used to indicate a strip of muslin rolled into a cylindrical form like tape. When other ma- terial than muslin is employed, as India-rubber, linen, flannel, crinoline, or silk, it is usually desig- nated as a rubber bandage, a linen bandage, or a crinoline bandage. Material. — Unbleached muslin of medium qual- ity, which costs about eight cents a yard, is best adapted for ordinary purposes. This may either be torn into strips of the proper length and breadth, removing the selvedge and leaving the ravel as much undisturbed as possible, or it may be cut, when a great number are required, as is now done at the Pennsylvania Hospital. By a very simple process used in the large cloth- houses, a piece of muslin can be cut into three hundred and sixty bandages in a few minutes. 10 THE ROLLER BANDAGE. Rolling. — The strip of muslin having been torn or cut, may be rolled either by hand, by a key, or by a macliine. In rolling by hand, one ex- tremity of the bandage is folded upon itself three or four times, when it is handled as a cigarette is rolled until the core becomes sufficiently firm to resist pressure on end. It is then held be- tween the thumb and index finger of the left hand, and is made to revolve upon its long axis by the thumb and fingers of the right hand, as shown in Fig. 1. Fig. 1. //X<#> V A bandage may be more quickly and firmly rolled by using a key, shown in Fig. 2. This is made of brass, has an ordinary key-handle, a tapering octagonal shaft, and a smooth tip. The THE ROLLER BANDAGE. 11 Fig. 2. dimensions of the shaft are, — four inches in length, one-quarter of an inch in diameter at the shoulder, and one-fifth at the tip. After fijiing one extremity of the bandage on the key, the latter is made to revolve by the right hand, while the left holds the tip of the instrument in its palm, and guides the course of the bandage between Fig. 3. Author's Ivky for RuLLiNo Bandages. the thumb and fingers. AVhen the roller has reached a certain size, it may be held in the man- ner shown in Fig. 3. Any tendency of the roller to run ofi* its proper course may be overcome by pressure with the little finger of the left hand, if it deviates towards the handle of the key, and by pressure with the index finger if towards the tip. 12 THE ROLLER BANDAGE. The bandage machine consists of a reel, witli a crank and octagonal shaft, mounted upon a base which is made to screw to a table. Set in the base are two uprights, which support wooden rods. Through these the bandage travels in its course from the left hand to the reel, their object beino^ to resrulate the direction and tension of Fig. 4. the roller. After the bandage is rolled, it may readily be withdrawn from the machine by re- versing the direction of the crank and pulling out the shaft, as the latter is quite movable. This apparatus is shown in Fig. 4. Size. — Although bandages vary in length from two to ten yards, and in width from three-quar- ters of an inch to four inches, there are two THE ROLLER BANDAGE, 13 sizes in coninion use with which abiiost any dressing may be applied. They are the roller (two and a half inches by seven yards) and the finger roller (three quarters of an inch by three yards). For children under ten years of age, the length and breadth of a bandage suitable for an adult may each be divided by tw^o. Uses. — The roller bandage is used for so great a variety of purposes that it would be quite beyond the scope of these definitions to attempt to enumerate them, except in the most general way. To retain almost all dressings and splints. To prevent or control oedema, oozing of blood or serum, spasm of muscles after fracture, or as itself a fracture dressing. In fact, almost every- where that surgical interference is required. Tension. — Too much care cannot be exercised in applying a bandage in each individual case, to estimate how much tension should be used, in order to fulfil the object for which it is employed, advantageously and prudently. A bandage may be applied lighfly, moderately ^ or loosely. These grades may be readily tried upon one's own person. A tight bandage makes a healthy hand throb. * A bandage moderately 14 THE ROLLER BANDAGE. applied gives the support of a comfortable glove, and a loose bandage is one which may retain a compress resting upon the eye without discom- fort. The conditions governing the tension of the roller will be formulated as (a) those de- pending upon the roller itself, and {b) those which exist in the part bandaged : a. 1. The Circumference of the Part bandaged. — The greater the circumference the more force must be used. Thus, in applying a roller to the lower extremit}', it is necessary, in order to secure an equal support for the entire limb, that each turn covering a greater circumference should be drawn a little more firmly than the preceding turn. The thigh turns requiring considerably more force to produce a given tension than those at the ankle. 2. Whether the Bandage includes the entire or only half the Circumference of the Limb, as in the Application of Splints. — When these are applied, much of the force used is expended upon them, the limb receiving less pressure than if the roller surrounded it alone. 3. Incomplete Bandaging. — Any bandage which leaves a considerable portion of the distal ex- THE ROLLER BANDAGE. 15 treniity of a limb uncovered is very liable to induce swelling:. If the hand or the foot is left uncovered, while the rest of the limb is bandaged, swelling is very likely to occur. Once started, it progresses very rapidly, because it increases the tension of the lower border of the bandage. This of course promotes the swelling, and so these active and passive agents react upon each other to the complete strangulation of the limb. 4. The Character of the Dressing beneath. — Where a mass of soft yielding material like cotton or charpie is interposed, much more force is neces- sary to give the requisite tension than where a thin dressing or none at all is used. 5. Increase of Tension from Flexion or Extension. — If a spica bandage is applied to the shoulder with the arm elevated, its tension will be much increased by bringing the arm to the side of the body. In the same manner the tension of a spica of the groin, applied with the thigh flexed upon the abdomen, will be increased when the latter is extended. 6. The Number of Tarns. — Each additional turn applied to the same part of a limb increases the tension nearly double. When, therefore, a roller IQ THE ROLLER BANDAGE. starts at the wrist, passes to the hand, and re- turns to the wrist, the latter receives too much tension, unless the first wrist turns are made very loosely. The same is true to a less extent when successive turns are made very close to- gether. 7. Shrinkage. — Due allowance should always be made for shrinking of the muslin, if it is known or suspected that from any cause it will become wet, h. 1. Texture and Condition of the Tissues. — Hard infiltrated tissue, such as is frequently found accompanying ulcers of the leg, requires very firm pressure, while very moderate pressure only can be employed in bandaging the flabb}' unresisting limbs of delicate children and aged persons. An acute inflammatory condition of a part will not admit of pressure, while very con- siderable tension is well borne by a doughy oedematous condition of the tissues. 2. Habit. — Independent of advance or sub- sidence of swelling, a bandage may be applied more firmly when the patient has become accus- tomed to its presence, 3. Situation. — Care must be observed, when THE ROLLER BANDAGE. 17 bandages about the chest are applied, that res- piration shall not be interfered with, particularly if the dressing is completed before the patient has quite recovered from the effects of an an- aesthetic. 4. Change in Position. — Marked swelling always occurs when a limb which has been kept hori- zontal for many weeks is suddenly allowed to hang. In this way a fixed dressing of silicate of Fig. 5. ■^/' ^ sodium or plaster of Paris, comfortable while the patient is on his back, frequently has to be cut when he gets up. Varieties. — The single roller, which is almost invariably used, and the double roller. They are shown in Fig. 5. Parts of the Roller. — The sins^le roller is com- posed of seven parts, — the initial and terminal extremities, the upper and lower borders, the h 2* 18 THE ROLLER BANDAGE. external and internal surfaces, and the body. The initial extremity is the free, and the termi- nal extremity is in the centre of the cylinder. The borders are designated according to the position they occupy when the subject stands erect. The surfaces are denoted by their relation to the centre of the cylinder, and the body in- cludes all. The double roller has eight parts, — two terminal extremities, two borders, two sur- faces, two bodies, and no initial extremity. APPLICATION. To Fix. — A roller is fixed by placing the ex- ternal surface of the initial extremity upon the point at which it is to start with the thumb and index linger of the left hand. With the body of the roller held in the right hand two turns are made in the direction taken by the hands of a clock. The first turn must be made by the right hand alone, after which the left hand, being free, may alternate with it. To Repeat. — To repeat is to make a second turn completely hide a preceding turn. This is always done in a circular bandage, and in fixing the initial extremity. THE ROLLER BANDAGE. 19 To Overlap. — To overlap is to make a second turn cover one-half, two-thirds, or three-quarters of a preceding turn. This is done in all spirals. To Recur. — To recur is to catch a turn at some point and reflect it upon itself, so that it either Ftg. 6. exactly retraces its course or slightly diverges in another direction (Fig. 6). This is done in re- FiG. 7. ^r^