Minor surgery : or, Hints on the every-day duties of the surgeon

Front matter

HINTS ON THE EVERY-DAY DUTIES OF THE SURGEON.

BY HENRY H. SMITH, M.D.,

Lecturer on Minor Surgery; Fellow of the College of Physicians ; Member of the Philadelphia Medical Society, etc.

Part First. On The Preparation And Application Of Dressings

Dressings, preparation and application of Instruments of Pieces of

Lint

Charpie

Cotton

Tow .

Compresses

Square

Triangular

Cribriform

Maltese Cross

Retractors

Perforated

Graduated

Pyramidal Adhesive strips

Baynton's use of Seton Poultices Plasters Irrigation Rules for dressing

6 CONTENTS.

Part Second. Of The Preparation And Application Of The Bandage

Bandage, preparation and application of the

PAGE

Section First. Of The Simple Bandage, Or The Roller

Roller, Simple .

Double-headed Application of Circular Oblique Spiral Uniting Dividing Compressing Expelling .

Retaining .

Reverses of .

Spiral Bandages of Chest

Abdomen

Penis

Fingers

all the Fingers, or Gauntlet

Demi-Gauntlet

Upper Extremity

Lower Extremity

French Crossed, or Figure of 8 Bandages of one Eye

both Eyes .

Angle of the Jaw

Contents

PAGE

Crossed, or Figure of 8 Bandage of the Jaw . 64

Barton's, for the Jaw ib.

Section Second

OF THE COMPOSITION AND APPLICATION OF THE COMPOUND BANDAGE, OR THE BANDAGE PROPER.

Bandage, application of Compound

T. Bandage .... of Head .

90 91 92

Nose ....

Chest .

Abdomen ....

Triangular T of Groin Double T of Pelvis ....

8 CONTENTS.

PAGE

Bandage, Double T of Hands .

T Perforated of Hand .

Invaginated

.

for Wounds of Lip ib.

Thillaye's

.

Invaginated of Body

.

for Longitudinal Wounds of the Extremities ib.

for Transverse Wounds of the Extremities

. 106

Dry Suture

•

. 107

Wry Neck ....

.

, 103

Jorg's Apparatus

.

. 109

Uniting, of Transverse Wounds of Neck

. no

Slings ....

. 112

Bandage of Galen .

ib.

Four-tailed Sling of Head .

.

. 113

Sling of Neck

. 114

Jaw

Face ib.

Mask ....

15, 135

Sling of Breast . ;

. .

Purses or Suspensories of Nose ib.

Scrotum .

9 ,

Sheaths ....

.

Laced or Buckled Bandages ib.

for the Knee ib.

Stocking

.

Gaiter .

ib.

Section Third. Mayors Handkerchief System

Handkerchief System Square Cap of Head Fronto-Occipital Triangle Occipito-Frontal Bi-Temporal Oculo-Occipital Fronto-Occipito-Labialis Cravat

122 131 132 133

ib.

CONTENTS.

y

Mayor's Handkerchief System.

PAGE

Facial Triangle

Vertico-Mental Cravat ib.

Occipito-Auricular .

ib.

Sternal Handkerchief

Fronto-Dorsal ....

Parieto-Axillaris ib.

Cervical Cravat

Simple Bis-Axillary Cravat

Compound Bis-Axillary Cravat ib.

Simple Bis-Axillo-Scapulary Cravat

Compound Bis-Axillo-Scapulary Cravat ib.

Dorso-Bis-Axillaris . -

Triangular Cap of Breast • • ib.

Sub-Femoral Handkerchief

Inter-Femoral Handkerchief

Single Spica Handkerchief ib.

Double Spica Handkerchief ib.

Suspensory or Handkerchief to Scrotum

Cervico-Brachial Sling .

ib.

Ante-Brachial Trough .

Triangular Cap of Shoulder

Triangular Cap of Amputations

Carpo-Olecranien Handkerchiefs

Flexor of Wrist ib.

Carpo-Dorsal Triangle .

ib.

Metatarso-Malleolar Cravat

Triangular Cap of Heel ib.

Tarso-Pelvien Cravat

Compound Metatarso-Rotular Cravat

Tarso-Patella Cravat

Triangular Cap of Foot ib.

Tibio-Cervical Sling •

Tibial Cravat . . .

Barton's Handkerchief ib.

Mayor's Hyponarthecia ,

Ante-Brachial Hyponarthecia

Hyponarthecia of Lower Extremities

Mayor's Clinical Frame

CONTENTS.

Section First. Op The Treatment Of Fractures

PAGE

Fractures, Treatment of of Skull .

Nose ....

ib.

Lower Jaw . .

ib.

Gibson's Bandage for

Vertebrae

Sternum

Ribs ..

ib.

Pelvis ib.

Clavicle ib.

Dessault's Apparatus for Boyer's . . .

Mayor's Fox's

201 204 206 207

Scapula

Velpeau's Bandage for Neck of Humerus ib.

Boyer's Bandage for

for Fracture of Shaft of Humeri ib. is 213 of the Condyles .

Physick's Apparatus for > Carved Splint Forearm .

ib.

Lower End of Radius

Barton's Bandage for ib.

Metacarpal Bones Phalanges .

Olecranon .

ib.

Astley Cooper's Apparatus for Dessault's .

Hospital

CONTENTS.

PAGE

Fractures, Boyer's Apparatus for, of the Olecranon 223

Gerdy's .... ib.

of Coronoid Process ... ib.

Fractures or the Lower Extremity . . 225

Elevator for Treatment of, . . . 228

Fracture of Femur .... ib.

Bell's Inclined Plane .... 229

Dupuytren's Inclined Plane ... ib.

Coates's Extending Band . . . 230

Physick's Gaiter . . . . 232

Coates's Perineal Band . . . 233

Junct-Bags ..... 235

Splint Cloth ..... ib.

Scultet's Bandage .... 236

Eighteen-Tailed Bandage . . . 237

Splints, for Dessault's ... ib.

Physick's .... 238

Hartshorne . . . 243

Amesbury's . . . 244

Gibson's Hagerdon . . . 248

Gibson's Simple-Inclined Plane . . 250

N. K. Smith's Splints . . . 251

Fracture of Patella .... 252

Dessault's Apparatus for . . . 253

Gerdy's . . . . ib.

Amesbury's ..... 256

Fracture of Leg .... 257

Hospital Fracture-Box ... ib.

Barton's Bran Dressing . . . 259

Starch Apparatus .... 260

Fractures of Fibula .... 267

Amesbury's Apparatus for . . ib.

Dupuytren's Apparatus for Fractures of the Lower

Extremity of the Fibula . . . 272

Apparatus for Fracture of the Os Calcis . 273

Dislocations ..... 275

CONTENTS.

Part Fourth Of The Minor Surgical Operations

PAGE

Bloodletting ... . 276

Phlebotomy

, 277

Bleeding in the Arm .

ib.

Spring Lancet

. 279

Thumb Lancet .

ib.

Bleeding in the Hand .

. 281

Jugular Vein ib

Ankle .

Arteriotomy

Local Bleeding

Leeching

Cupping . .

Scarification, or Fly-bites

Cutaneous Irritations ib.

Frictions ib.

Blistering

• 294

Setons .....

ib.

Issues .....

Moxa . . . .

Vaccination ....

Injections . . .

Tooth-Drawing

MINOR SURGERY.

In the strict acceptation of the term, Minor Surgery means that portion of surgery proper, which treats of the minor surgical operations and the employment of such means for the cure of diseases, as do not require the division of our tissues, or, in other words, constitute a capital operation. Under this head is, therefore, included the preparation and application of Dressings ; the treatment of Fractures and Dislocations, and such minor operations and duties as every Surgeon is hourly called on to perform, and on the proper performance of which rests much of his reputation, as though apparently simple and too often looked upon as matters which any one can attend to, yet in reality difficult, and requiring much method and ingenuity to adapt the means to the end in view.

In the systematic consideration of the subject, four divisions naturally present themselves : — 1st, Dressings ; 2d, Bandages ; 3d, Apparatus for Fractures and Dislocations ; and 4th, Minor Operations.

Part First. On The Preparation And Application Of Dressings

Dressings may be defined to be those portions of different substances, which are applied directly to operated or injured surfaces, and are designed to facilitate the reunion of divided parts, to protect them from external injuries, to serve as means for the application of different medicaments, and also to absorb discharges, protect neighbouring parts, and ensure cleanliness.

The different articles employed and the means by which they are applied, are known under the one general head of apparatus of Dressing ; and consists of two parts, one containing the Instruments of Dressing, the other the Pieces of Dressing to be employed.

The Instruments of Dressing are those which are generally found in the assemblage furnished by the cutlers, and known under the name of the Pocket Case. This contains Dressing or Ring Forceps ; Simple Forceps ; Scissors, both straight and curved ; Probes and Directors ; Spatulae ; Bistouries ; Abscess Lancets ; Porte Caustic ; Tenacula ; Straight and Curved Needles ; Ligatures ; and often such others as the taste of the cutler or his interests may lead him to select. Under the same head should also be included

MINOR SURGERY.

Razors, Basins, Sponges ; and all that is requisite for the preparing of a part for the application of the dressing.

The Pieces of Dressing are Lint; Charpie ; Cotton ; Tow ; Spread Cerate, or other ointment ; Compresses ; Malteese Cross ; Shields for Amputations; Adhesive Strips; Setons ; Poultices; Plasters ; and Irrigations.

Lint is a soft, delicate tissue or mass, prepared in two ways; — in one of which the transverse threads of soft old linen are drawn out by a machine, leaving the longitudinal ones covered by a sort of tomentum or cotton-like mass ; the other,

Fig. l.

in which the cotton-like surface is produced by scraping, with a sharp knife, a similar piece of cloth, previously fastened to some firm substance.

MINOR SURGERY.

The first is known as the Patent Lint, and may be obtained at any apothecaries, as it is now generally manufactured ; the second, is the Domestic Lint, and may be made at a moment's notice where the first is not convenient. They are both employed as primary dressings, either spread with ointments or alone.

Charpie is a substance much employed by the French surgeons, and worthy of a more general application in the United States. It consists of a collection of filaments, separated from morsels of old linen rag, four or five inches square, of loose texture, and well calculated to absorb. It is divided into two kinds, according to the length and fineness of the thread composing it ; that which is long and coarse being employed to keep open sinuses, fistulse, and as an outer dressing, while the softer, finer kind may be placed in immediate contact with the part, especially where the surface requires stimulation.

Various names are given to charpie, according to the way in which its fibres are arranged, previously to its application ; thus there is the Plu~ masseau, Bourdonnet, Tente, Meche, Boulette, Tampon, and Pelote ; each of which have their peculiar advantages.

The Plumasseau is a mass of charpie, the filaments of which are laid parallel to each other, and the ends folded under and flattened between the palms of the hands, so as to make a thick mass with rounded edges. As thus

Fig. 2.

MINOR SURGERY.

formed, it is usually spread with cerate, and neatlyadapted to the parts it is to cover, care being taken that it is not so thick as to overload and heat the part, nor yet so thin as to become quickly saturated with the pus.

The Bourdonnet is a smaller mass of charpie, formed by rolling its fibres longitudinally between the hands, so as to make an oblong mass, which is tied firmly in the middle, so that when the ends are brought in contact laterally, it may form a sort of cone. It serves for absorbing pus in deep-seated wounds, where there is a tendency in the edges to close, before the bottom has filled up. It is also useful in arresting hemorrhages from deep-seated vessels ; pressure being made by forcing the central part upon the vessel, while the loose tissue made by the ends assists in the formation of the clot.

The Tente is the name given to conical or cylindrical masses or plugs of charpie, which are like the Bourdonnet, except that instead of applying a string to its middle, it is there doubled on itself and the loose ends twisted by the fingers, so as to give it a spiral form and make the apex of a cone, the base of which is the part where the fibres were doubled on themselves. It is employed to dilate fistulous canals or openings which are too small to allow of the free escape of pus, aud answers very well for moderate dilatation, 2*

MINOR SURGERY.

But where parts are rigid, the Sponge Tente, or that made by slicing gentian, carrot, or some other porous root, answers better. The Sponge Tente is prepared by saturating common sponge with melted bees-wax, allowing it to cool and harden, and then slicing it into small pieces, of such a size as will nearly fill the orifice to be dilated. The heat of the part melts the wax, the sponge fills with the fluids of the part and gradually dilates it : after which a new morsel must be introduced.

The Meche is an assemblage of filaments of charpie, arranged parallel to each other and doubled at the centre. It is of great use in the treatment of fistula, especially fistula in ano. When prepared, it is anointed with cerate and introduced into the cavity on the point of a probe ; as it prevents the edges from healing, it causes the cavity to fill gradually from below upwards.

Boulettes are little balls of different sizes, made by rolling charpie between the hands until it acquires this form. They are extremely W porous and absorbent, and are useful in filling up purulent cavities, and preventing the matter from burrowing.

When a number of Boulettes are placed together at the bottom of any cavity, either with a view of distending it, or of arresting hemorrhage, they take the name of Tampon, They are often used in gonorrhoeal inflammations of the vagina and to arrest uterine hemorrhage ; for the latter purpose, especially if the hemorrhage follows an operation, they are made of the Boletus Igniarius, or puff-ball.

The Pelote is a large boulette, sur- Fig. 7. rounded by a piece of soft rag, the edges of which are brought together and tied firmly. It is occasionally employed in the treatment of herniae, especially the umbilical hernia of children, where, when bound down by adhesive strips or a bandage, it answers very well the purpose of a truss. It is also useful in the compression of large vessels, as in wounds of the axillary artery, and also in hemorrhage from parts in the neighbourhood of the rectum, being there confined under a T bandage.

Cotton and Tow are substances which are too well known to require a description. Both are of comparatively limited utility as dressings, their places being usually supplied by charpie. Before, however, the application of either to surgical purposes, they should be well picked or carded to free them from foreign matters. The chief use of cotton is as a dressing for superficial burns, where it is useful by protecting them from the air and by absorbing the discharges ; thus forming a sort of scab under which they readily heal. When intended to be thus used, it is especially necessary to see that it is free even from specks, as the fly is exceedingly apt to lay its egg here, where it is vivified by the heat of the body, and generates maggots, to the great annoyance of the

MINOR SURGERY.

patient and the astonishment of all around him, as they are unable to account for their appearance, and regard it as a fatal sign.

Tow is employed chiefly as an outer dressing to stumps which are discharging freely, as it absorbs well. Care is requisite in forming the Plumasseau of Tow for this purpose, that it be not too thick and heating, as union is often thus prevented.

Compresses are pieces of linen which are used for confining dressings in their proper situations ; preserving wounds from external injuries ; equalising the surface of limbs for the proper adaptation of bandages, and also for the compression of soft parts. They should be made of some soft substance free from hems or darns, and, with one or two exceptions, applied over other dressings. Where they are intended to be placed directly on a wound, they should always be made of soft linen. Compresses have received various names according to the way in which they are folded or the indications to be fulfilled ; thus we have the Square, Oblong, Triangular and Cribriform Compress, the Malteese Cross, the Half Malteese Cross, the Single and Double Split Compress, the Perforated, the Graduated, and the Pyramidal Compress.

The Square compress is that in which the substance used has the same dimensions in its two principal diameters. If it is twice as long as it is broad, and will form a square when doubled in its length, it forms the Oblong Compress, and

Fig. 8.

MINOR SURGERY.

is useful in surrounding the trunk, or limbs. When

a square piece of linen is folded so as to unite

two of itsangles,itformsthe Triangular Compress,

and is exceedingly useful

in confining dressings to

stumps, when it is desirable

to remove the dressing often

without deranging the limb.

To apply it for this purpose,

cut one of such a size as will

surround the limb, place the

stump in the centre of the

side a b ; then turn up the apex c, and after

wards the points a and b.

The Cribriform Compress is a square piece of linen pierced with a number of holes, and intended when spread with cerate to be applied directly to a suppurating surface ; the pus passing out through the holes allows the compress to remain constantly in contact with the surface, and thus prevents the wound

from being constantly bathed in pus. It also assists in the removal of other dressings, by preventing them from sticking to the part. It is formed by folding linen four or six times on itself, so as to form several oblong squares, one within the other, and then nicking the sides in several points with the scissors, so as to remove l ii i i

MTNOlt SURGERY.

small pieces ; on opening it, we have the form

desired.

The Malteese Cross, so named from its shape, is formed from the common square compress by folding it into an oblong square, doubling this in its length to form a smaller square — joining two of the angles to form a triangle, as in the figure; and folding this equilaterally to form a smaller triangle, then mark a line on its hypothenuse half an inch from its apex, and slit the sides down to this line, which is dotted in the figure. On opening it out we have

a very regular cross, with a space in the centre,

which is to cover the front of the stump.

The cross is of great use as a primary or secondary dressing to stumps, as by means of the slits it will fold over and fit the part very accurately.

The Half Malteese Cross is formed by slitting the two angles of the loose side of an oblong square to within an inch or two of their centre, as seen in the figure, and serves a better purpose than the

MINOR SURGERY.

full cross, in some cases, as in stumps at the shoulder, or after amputation at the hipjoint, &c.

The Single Split Compress is an oblong piece of muslin split as represented in the cut, and intended to be used as a shield or retractor in amputations of the arm or thigh. The tails are passed on each side of the bone, and drawn downwards while the upper part is turned upwards over the stump, so as to draw the muscles back and protect them from the action of the saw. The diamond shape opening at the end of the split is intended to adapt it more accurately to the bone itself.

The Double Split Compress, or retractor of three tails, differs from the preceding one only in its being split into three tails instead of two. It is employed with the same view after amputations of the forearm and leg ; the third tail being pushed through the interosseous space, protects more thoroughly both the bones of the part.

The Perforated Compress (Fig. 16) is the name given to a piece of muslin folded several times on *

O

MINOR SURGERY.

Fig. 16. itself so as to make a thick mass, in the centre of which an opening is made. It may be employed to relieve points of pressure, especially where they have a tendency to slough, as on the internal condyle in fractures of the arm, and on the heel in fractures of the lower extremity ; the sore point being placed in the centre of the opening, so as to save it, whilst the pressure is borne by the parts on its circumference.

Graduated Compresses are named from their construction, and are of several kinds, the substance of each being folded differently according to the object in view.

The Common Graduated Compress is formed by folding a piece of muslin several times on itself, so that each fold may not entirely cover the one that has preceded it. It may be graduated from one end, or from the circumference to the centre, as Fig. 18. seen in Figures 17, 18.

The Pyramidal Compress is one that is most accurately formed by placing on one another, square pieces of muslin gradually decreasing in size so as to form a pyramid (Fig. 19) ; or by folding a piece of 2\ inch bandage on itself, so as to form a compress graduated from end to end, and then placing a piece

MINOR SURGERY.

of cork or other body in the centre of the last turns.

Thus formed, it is very useful in making pressure upon certain points, as in cases of hemorrhage from deep seated vessels.

Adhesive Strips are pieces of linen spread with some adhesive plaster, usually diachylon, and intended to promote the union of divided parts. They may

MINOR SURGERY.

be prepared from the sheet on which it is usually spread, by sliding the scissors according to the line of the thread of the cloth and slitting it into pieces about three-quarters of an inchin width (Fig. 20),andofalengthsufficienttoenableittoextendat least three inches beyond each side of the wound, which is to be united. Before applying them, it is generally necessary to soften the plaster by heat ; and the most convenient method of so doing is to fill a bottle with boiling water and wrap the strip around it, the outside of the strip being next the surface of the bottle. In applying it, the strip should be first placed on the portion of the wounded surface that is most depending, so as to draw it up to the other, the intervals between the straps being such as to allow of the free escape of the matter. For removing them, they should be softened by washing the part with warm water, or by applying a warm poultice to it a few hours before the dressing is removed. The surgeon then lays hold of one of the extremities of each piece in succession, and gently raising it, reflects it upon the wound. This extremity being detached to within half an inch of the edges, he detaches the other to about the same distance, and holding them together, lifts them perpendicularly, taking care at the same time to apply the thumb and index finger of the left hand upon the sides of the wound, to prevent injury being done to the cicatrix. (Fig. 21.)

As adhesive strips sometimes irritate and inflame the part, owing to their tearing out the small hairs or down which cover it, their application is frequently followed by erysipelas. In this case their places may be very well supplied by the slit and tail, or uniting bandage hereafter mentioned. Adhesive strips are also very useful as a dressing to ulcers, or for compression in cases of Orchitis or Hernia Humoralis.

As the treatment of ulcers by the use of adhesive strips is of considerable importance, a detailed account of Baynton's plan is here given.

Several strips of adhesive plaster, the manner of preparing which has been already described of about two inches in breadth, and sufficiently long to pass round the limb and leave an end of about four or five inches ; several longitudinal compresses made of soft calico, and a calico roller about three inches in breadth, and varying from four to six yards in length, according to the size of the limb, are first prepared. Then one of these strips is to be applied to the sound side of the limb, opposite the inferior part of the ulcer, so that the lower edge may be placed about an inch below the lower edge of the sore, and the ends drawn over the lower part of the ulcer, with as much gradual extension as the patient can conveniently bear ; the other strips are then applied in the same manner, each above and in contact with the other, until the whole surface of the sore and of the limb is covered from one inch below to two or three inches above the affected part.

The whole of the leg, if it is the part affected, should then be covered equally with the longitudinal compresses, and the roller applied round the limb, from the toes to the knee, with as much firmness as the patient can support without complaint. One or two spiral turns of the roller should be first passed round the ankle-joint, then as many round the foot as will cover and support every part of it, except the toes, and the same continued up the limb as far as the knee ; the roller should be carried from the ankle upwards in reverses, as many of them being made as the parts require, in order that each turn may lie flatly on the limb. Should the parts be much inflamed, or the suppuration very abundant, the applications are to be wetted frequently with cold spring-water. The patient may take exercise if he pleases, as this will be found to alleviate the pain and tend to accelerate the cure. The bandage ought to be daily applied soon after rising in the morning, when the parts are most free from tumefaction ; and the force with which the ends of the plasters are drawn over the limb gradually increased as the parts return to their natural state of ease and sensibility. When the cure is thus far accomplished, the roller should be applied with as much tightness as the patient will bear, more particularly if the limb be in that enlarged or compressible state denominated scorbutic, or if the edges of the wound be thickened.

We may remark, that this bandage is liable to produce excoriations of the limb, but these are never serious except when they occur over the Tendo-Achillis. To prevent them or accelerate their disappearance, Mr. Baynton recommends the application of a small shred of soft leather under the adhesive plaster : or a bit of sheet-lead may be used in place of the shred of leather, as it answers better.

During the years 1S30 and 1S31, several of the most eminent surgeons of Paris submitted Baynton's method of compression to a series of experiments, which, as the result will show, were highly favourable to it. Velpeau found the average time of cure ten, fifteen, or twenty days, for ulcers of three, four, or five inches in circumference. Ph. Boyer, who perhaps pushed the experiments further than any one else, found the average period of treatment, calculated upon a large number of cases, to be twenty-six days ; and this result is so much the more striking, as Duchatelet was noticing at the same period the average length of time required by the older methods, which he found in six hundred and ninety cases to be fifty-two days 3* and a half, giving a difference of more than half in favour of Baynton's plan. In the course of these experiments some modifications were introduced ; as, for instance, that by Velpeau and Ph. Boyer,of the substitution of good diachylon plaster for the mixture of Baynton. So, with respect to the breadth of the plasters, the above surgeons found them more advantageous when only an inch or an inch and quarter broad. In the course of the experiments, Roux and Ph. Boyer found that the inflammatory state of the ulcer did not counterindicate the employment of compression, which often arrested, even, its secondary effects. Marjolin, however, recommended the reducing of the inflammation before proceeding to compression. Velpeau and Roux extended the compressive treatment to contused wounds with disorganisation of the skin, which were getting into an atonic state, and also, to every species of wounds witli or without loss of substance when the cicatrization was slow, or otherwise checked by a general vice of the constitution, attending, however, in the lat^ ter case to internal remedial agents calculated to benefit the system. Ph. Boyer endeavoured to cure syphilitic and scorbutic ulcers by compressive strips alone, but without success ; while, by exerting this species of compression, and employing, at the same time, the ordinary internal remedies, the cure was remarkably hastened.

Ph. Boyer's observations all tend to support the opinion of Baynton himself, that, when the leg is properly bandaged, walking, at least moderately, tends to facilitate the cure, and renders it more complete. With regard to the periods of renewing

MINOR SURGERY.

the bandage, Velpeau found it quite sufficient to change it every three, four, or five days, according to the degree of irritation. Boyer never dressed them oftener than once in forty-eight hours. Valbrune considered it necessary to renew the bandage oftener if the cessation of swelling caused it to become relaxed, but agrees with Velpeau and Boyer in thinking that the less often the bandage is disturbed the better.

It may perhaps be useful to the young surgeon to say that the use of adhesive strips to suppurating surfaces often produces a marked blackness of the skin. This is nothing but a chemical change produced in the plaster by the action of the discharges, and not the forerunner of gangrene as many have at first supposed. Nothing answers so well for a compressive bandage of the testicle in cases of Epididymitis, or chronic enlargement of the testicle, as strips of adhesive plaster. In order to apply them in this case, the swelled testicle should be forced to the bottom of the scrotum, by surrounding the cord with the thumb and fingers of one hand so as to form a ring, while with the oth^r, or with the hand of an assistant, the strips are so applied as to surround the part entirely as seen in Fig. 23.

These strips should be of the width of the thumb, and applied over one another from

Firr. 23.

^JiF below upwards, till the testis and a part of the eord are compressed between them. Previous to their application the parts should be cleansed and well shaved ; and the strips should be renewed as often as they become slack from the abatement of the swelling in the testicle.