Minor surgery, including bandaging

Preface To The Ninth Edition

In the preparation of this edition the attempt has been made to make the book conform strictly to its title. Major operative procedures, demanding a large special experience in surgery, have been excluded as not properly germane to this work. They require a fuller discussion and description than could be allotted to them.

Space has thus been obtained for the presentation of recent additions to our resources which are of general utility, such as the simpler methods of transfusion of blood, the indications and essentials of debridement, the chlorine antiseptics and the Dakin-Carrel method of treatment of wounds. Increased recognition is given to local anesthesia for minor surgery, and the chapter on surgical bacteriology and immunology has been modernized.

Many smaller changes and additions have been made throughout, to cover recent improvements in practice, and it is hoped that the book will continue to meet with the same cordial approval of student and practitioner as the previous editions.

The author wishes gratefully to acknowledge the invaluable assistance of Dr. Damon B. PfeifTer, who made many helpful suggestions, and who read the proof and supervised the passage of the book through the press.

H. R. W.

Philadelphia, 1922.

Part I. Bandaging

The Roller Bandage 18

Dimensions of Bandages 20

General Rules for Bandaging 21

Removal of Bandages 22

Varieties of Bandages 23

Circular Bandage 23

Oblique Bandage 23

Spiral Bandage 23

Spiral Reversed Bandage 24

Spica Bandage 26

Figure-of-eight Bandage 26

Recurrent Bandage 27

T-bandage 28

Double T-bandage 30

Many-tailed Bandages or Slings . . .' . . . .31

The Occipito-frontal Triangle 36

The Mento-vertico-occipital Cravat 37

The Bis-axillary Cravat 37

The Dorso-axillary Cravat 38

The Compound Dorso-bis-axillary Cravat .... 38

Triangular Cap or Suspensory of the Breast .... 39

The Gluteo-femoral Triangle 40

Gluteo-inguinal Cravat 41

Barton's Bandage • 43

Modified Barton's Bandage 43

Gibson's Bandage 46

Oblique Bandage of the Angle of the Jaw 47

Recurrent Bandage of the Head 48

Transverse Recurrent Bandage of the Head ..... 50

V-bandage of the Head > 50

Head-and-neck Bandage 51

Crossed Bandage of One Eye 52

Crossed Bandage of Both Eyes 53 vi CONTENTS

Occipito-facial Bandage 54

Oblique Bandage of the Head 54

Occipito-frontal Bandage 55

Spiral Bandage of the Finger . 56

Spiral Reversed Bandage of the Fingers 57

Gauntlet Bandage 57

Demi-gauntlet Bandage 58

Complete Bandage of the Hand 59

Spica Bandage of the Thumb 60

Spiral Reversed Bandage of Arm 60

Spiral Reversed Bandage of Upper Extremity .... 61

Figure-of-eight Bandage of the Elbow 62

Spica Bandage of the Shoulder (Ascending) 63

Spica Bandage of the Shoulder (Descending) ..... 65

Figure-of-eight Bandage of Neck and Axilla ..... 66

Velpeau's Bandage 66

Desault's Bandage 68

Arm and Chest Bandage 71

Bandages of the Trunk 73

Spiral Bandage of the Chest 73

Anterior Figure-of-eight Bandage of the Chest .... 73

Posterior Figure-of-eight Bandage of the Chest .... 74

Suspensory and Compressor Bandage of the Breast ... 75

Suspensory and Compound Bandage of Both Breasts . . 76

Single Spica Bandage of the Groin (Ascending) .... 77

Single Spica Bandage of the Groin (Descending) .... 79

Double Spica Bandage of the Groins 80

Spica Bandage of Buttock 82

T-bandage of Perineum 83

Figure-of-eight Bandage of Knee ........ 83

Figure-of-eight Bandage of Both Knees ...... 85

Complete Bandage of the Foot 86

Spica Bandage of the Foot 86

Bandage of Foot Covering the Heel (American) .... 87

Bandage of Foot Not Covering the Heel (French) . . .88

Bandage of the Heel ..... ...... 89

Spiral Reversed Bandage of the Lower Extremity ... 89

Spiral Reversed Bandage of the Thigh 90

Figure-of-eight Bandage of the Leg 91

Spiral Reversed Bandage of the Penis ....... 92

Bandage of the Perineum 92

Recurrent Bandage of a Stump 92

Bandage for Securing the Hands and Feet in the Lithotomy

Position 94

Liebreich's Eye Bandage 94

Borsch's Eye Bandage 95

Bandages of Scultetus • 95

Gauze Bandages -

Flannel Bandage 99

Black Muslin Bandages 101

CONTENTS vn

The Rubber Bandage 101

Elastic webbing Bandage 103

Plaster-of -Paris Dressings 104

The Bavarian Dressing 112

Moulded Plastic Splints 113

Trapping Plaster-of-Paris Bandages 114

Removal of Plaster-of-Paris from the Hands 114

Removal of the Plaster-of-Paris Bandage .115

Use of Plaster-of-Paris Dressings 117

The Starched Bandage 117

Silicate of Potassium or Sodium Bandage 118

The Paraffine Bandage 119

Moulded Splints . . . 119

Raw-hide or Leather Splints 119

Binder's Board or Pasteboard Splints 120

Porous Felt Splints 121

Hatter's Felt Splints 121

Elastic Cotton Bandage 121

Part II. Minor Surgery

Materials Used in Surgical Dressings 123

Poultices 131

Irrigation 134

Counter-irritation 138

Asphyxia or Apnea 162

Exploring Syringe 172

The Stomach-tube 172

The Stomach-pump 173

Esophageal Bougie 174

The Rectal Tube 174

Rectal Bougies 175

Enemata 175

Vaccination 176

Hypodermic Injections 177

Exploring Needle 182

Skin Grafting 182

Bone Transplantation or Bone Grafting .185

Electrolysis 188

Galvano-cautery 188

Faradization 189 vm CONTENTS

The Cystoscope 189

The Urethroscope 191

The Panelectroscope 191

Catheterization of Ureter in Males 191

Estimation of the Functional Capacity of the Kidneys . 192 Direct Laryngoscopy, Bronchoscopy, Esophagoscopy and Gastros-

copy 193

Massage 194

Application of Hot Air or Baking 195

Bier's Hyperemia Treatment 196

Active or Arterial Hyperemia 199

Skiagraphy, or Employment of the Roentgen Rays . . . .199

Roentgen-ray or Radium Therapy 202

Local Anesthesia 209

Infiltration or Terminal Anesthesia 214

Epidural or Sacral Anesthesia 215

General Anesthesia 218

Acidosis, or Acid-intoxication 241

Trusses for Hernia 241

Ligatures Used in the Treatment of Vascular Growths . . . 270

Constitutional Treatment . . .... 275

Local Treatment 275

Temporary Control of Arterial Hemorrhage 275

Permanent Control of Arterial Hemorrhage 282

Treatment of Venous Hemorrhage 289

Treatment of Capillary Hemorrhage 291

Consecutive or Reactionary Hemorrhage 292

Treatment of Secondary Hemorrhage 292

Subcutaneous Hemorrhage 292

Control of Hemorrhage of Special Parts 293

Acute Abscess 299

Tuberculous or Chronic Abscess 300

Diffuse Suppuration 302

Sinus and Fistula 302

Shock 304

Incised Wounds 308

Lacerated Wounds 309

Contused Wounds 311

Punctured Wounds 311

Stab Wounds 312

Poisoned Wounds 312

Scalp Wounds 313

Gunshot Wounds 314

Blank-cartridge Wounds , . 315

Powder Burns 323

Contusions or Bruises " 324

Sunburn 324

Brush-burn 324

CONTENTS ix

Burns and Scalds 325

Effects of Cold 332

Injuries from Electricity 333

Lightning Stroke 334

Roentgen-ray Burns 335

Bed Sores (Decubitus) 336

Contusion of Joints 337

Hemarthrosis . . 337

Sprains of Joints 337

Wounds of Joints 338

Sprain-fracture 341

Strains of Muscles and Fascia 341

Septicemia or Sepsis 343

Pyemia 344

Sapremia 344

Erysipelas 345

Cellulitis 346

Air Embolus 347

Fat Embolism 347

Thrombosis 348

Embolism 349

Gangrene 349

Noma, Gangrenous Stomatitis, Cancrum Oris .... 356

Tetanus 357

Removal of Foreign Bodies 362

Furuncle, or Boil 367

Carbuncle 367

Varicose Veins .... . . 370

Part III. Asepsis And Antisepsis

Immunity 384

Antitoxins 384

Phagocytosis and Opsonic Treatment 385

Bacterial Vaccines 385

Leukocytosis 386

Varieties of Bacteria 387

Putrefactive Bacteria 393

Protozoa 394

Theory of Asepsis and Antisepsis in Wound Treatment . . . 394

Methods of Disinfection or Sterilization . 396

Agents Employed to Secure Asepsis 399

Preparation of Materials Used in Aseptic Operations . . 410 Methods and Dressings Employed to Secure Asepsis in Treatment of Wounds 421

CONTENTS

Part IV. Fractures

General Consideration of Fractures 437

Examination of Fractures 442

Repair of Fractures 443

Provisional Dressings of Fractures . . . . • . . . . . . 444

Transportation of Fractures of the Extremities 445

Reduction or Setting of Fractures . 446

Materials and Appliances Used in the Dressing of Fractures . 447

Operative Treatment of Simple Fractures .451

Separation of the Epiphyses 452

Dressing of Special Fractures ...'...• 454

Fracture of the Nasal Bone 454

Fracture of the Malar Bone and Zygoma 455

Fractures of the Upper Jaw 456

Fractures of the Lower Jaw 457

Fracture of the Hyoid Bone 459

Fractures of the Larynx and Trachea 459

Fractures of the Ribs 460

Fractures of the Costal Cartilages 461

Fractures of the Sternum 461

Fractures of the Pelvis 462

Fractures of the Sacrum and Coccyx 462

Fractures of the Vertebrae 463

Fractures of the Skull . . . . 464

Fractures of the Clavicle . 465

Fractures of the Clavicle in Children . . . . . . 470

Fractures of the Scapula 471

Fractures of the Olecranon Process of the Ulna . . . .482

Fractures of the Coronoid Process of the Ulna .... 484

Fracture of the Shaft of the Ulna 484

Fractures of the Head and Neck of the Radius .... 484

Fractures of the Ulna and Radius 485

Incomplete Fractures of the Ulna and Radius . . . .486

Fracture of the Lower End of the Radius 487

Reversed Colles' Fracture .492

Fractures of the Carpal Bones 492

Fractures of the Metacarpal Bones 492

Fractures of the Phalanges . . . 493

Fractures of the Femur 494

Fracture of the Shaft of the Femur in Children . . . . 506

Fracture of the Patella 508

Rupture of the Quadriceps Extensor Tendon 511

Fractures of the Tibia 511

Fractures of the Tibia and Fibula 511

Fractures of the Fibula 516

Fractures of the Tarsal Bones 518

Fractures of the Metatarsal Bones 519

Fractures of the Phalanges of the Toes . . . .' . . 519

CONTENTS XI

Ununited Fractures 524

Bone Transplantation in Ununited Fracture 526

Deformed Union 527

Part V. Dislocations

General Consideration of Dislocations 529

Special Dislocations 531

Dislocations of the Vertebrae 531

Dislocations of the Coccyx 532

Dislocations of the Lower Jaw 532

Dislocation of the Hyoid Bone 533

Dislocations of the Ribs and Costal Cartilages .... 533

Dislocations of the Sternum 533

Dislocations of the Pelvis 534

Dislocations of the Clavicle 534

Dislocations of the Scapula . 536

Dislocations of the Shoulder . 536

Dislocations of the Elbow 541

Dislocations of the Head of the Radius 543

Dislocation of the Upper End of the Ulna 544

Dislocations of the Wrist 544

Dislocations of the Bones of the Carpus . . . . . . 545

Dislocations of the Metacarpal Bones 546

Dislocations of the Fingers . 546

Dislocations of the Hip 548

Dislocations of the Patella 554

Dislocations of the Knee 554

Dislocations of the Semilunar Cartilages 555

Dislocations of the Fibula 556

Dislocations of the Ankle 556

Dislocations of the Tarsal Bones 557

Dislocations of the Metatarsal Bones and Phalanges of the

Toes 558

Old Dislocations 558

Compound Dislocations 559

Complicated Dislocations 559

Habitual, Pathological and Congenital Dislocations . . 560

Part VI. Operations

Amputations of the Fingers and Metacarpal Bones .... 561

Amputations of the Fingers . 562

Amputation of the Finger through the Metacarpo-phalangeal

Articulation 563

Amputations of the Metacarpal Bones 564

Dressing of Amputations of Fingers and Hand . ■ . . . 567

Amputations of Toes and Metatarsal Bones 567

Amputations of the Toes 567

Amputations of the Metatarsal Bones 570 xii CONTENTS

Warts or Verruca 571

Papilloma 571

Callosity 571

Clavis or Corns 572

Sebaceous Cysts or Wen 572

Paracentesis Thoracis 573

Paracentesis Abdominalis 573

Paracentesis Pericardii 574

Paracentesis Vesicae 575

Lumbar Puncture 575

Circumcision 576

Varicocele 577

Treatment of Hydrocele 577

Ingrown Toenail 578

Paronychia 580

Felon or Whitlow 580

Palmar Abscess t ..... . 582

Tracheotomy . 582

Laryngotomy 588

Laryngo-tracheotomy 589

Intubation of the Larynx 589

Part VII. Ligation Of Arteries

Ligation of Special Arteries 599

Ligation of the Innominate Artery 599

Ligation of the Subclavian Artery 600

Ligation of the Vertebral Artery 602

Ligation of the Inferior Thyroid Artery 602

Ligation of the Internal Mammary Artery 602

Ligation of the Common Carotid Artery 603

Ligation of the External Carotid Artery . * 604

Ligation of the Internal Carotid Artery 605

Ligation of the Superior Thyroid Artery 605

Ligation of the Lingual Artery 605

Ligation of the Facial Artery 606

Ligation of the Occipital Artery 606

Ligation of the Temporal Artery 607

Ligation of the Axillary Artery 607

Ligation of the Brachial Artery 609

Ligation of the Radial Artery . . . 610

Ligation of the Ulnar Artery 612

Ligation of the Interosseous Artery 613

Ligation of the Abdominal Aorta 613

Ligation of the Common Iliac Artery 614

Ligation of the Internal Iliac Artery 615

Ligation of the External Iliac Artery 615

Ligation of the Gluteal Artery 617

Ligation of the Sciatic and Internal Pudic Arteries . . . 617

Ligation of the Femoral Artery 618

Ligation of the Popliteal Artery 620

Ligation of the Anterior Tibial Artery 6i'0

Ligation of the Dorsalis Pedis Artery 622

Ligation of the Posterior Tibial Artery 622

PART T.

Bandages. — These constitute one of the most widely used and important surgical dressings ; they are employed to hold dressings in contact with the surface of the body, to make pressure, to hold splints in place in the treatment of fractures and dislocations, and to maintain in their natural position parts which may have become displaced.

Bandages may be prepared of various materials, such as linen, crinoline, flannel, gauze or cheese-cloth, rubber-sheeting, or muslin, bleached or unbleached ; the latter material is the most commonly employed, by reason of its cheapness ; flannel, from its elasticity, is sometimes used, but its employment for bandages is now generally limited to its use in dressings for operative work in connection with the eye and abdomen, and for a primary roller in the application of plaster-of- Paris dressings.

Bandages are either simple, w T hen composed of one piece of material, such as the ordinary roller-bandage, or compound, when prepared of one or more pieces adapted by size and shape to particular objects.

The importance of being familiar with the general rules of bandaging and proficient in the application of the roller-bandage cannot be overestimated, and both the student and the general practitioner will never have cause to regret the time occupied in learning to apply neatly this form of surgical dressing;

2 !7

BANDAGING.

A well-applied bandage adds to the security of the dressing and the comfort of the patient, and the method of application often secures for the physician the confidence both of the patient and of his friends ; while, on the other hand, a badly applied bandage is apt to be uncomfortable and insecure, and to meet with their adverse criticism.

The Roller-bandage. — The roller-bandage consists of a strip of woven material, prepared from some one of the materials previously mentioned, of variable length and width according to the portion of the body to which it is

Fig. 1.

Bandage-winder.

to be applied ; this, for ease of application, is rolled into a cylindrical form.

The material commonly employed for the roller-bandage is unbleached muslin, although, for special purposes, linen, flannel, rubber-sheeting, crinoline, gauze or cheesecloth may be used. It is important that the roller-bandage should consist of one piece, free from seams and selvage, for if made of a number of pieces sewed together, or if it contains creases or selvage, it cannot be so neatly applied, and it is not so comfortable to the patient, as it is apt to leave creases upon the skin.

THE ROLLER-BANDAGE. 19

In preparing the ordinary muslin bandage, the material is torn in strips varying in length and width according to the part of the body to which it is to be applied, and it is then rolled into a cylinder, either by the hand or by a machine constructed for the purpose (Fig. 1).

It is important that every student and practitioner should be able to roll a bandage by hand, for in practice the medical attendant may at any moment be called upon to prepare a bandage, in order to apply a dressing, and the art of preparing a bandage is easily acquired by a little

Fig. 2.

Rolling a bandage by hand.

practice. To roll a bandage by hand, the strip of muslin should be folded at one extremity several times until a small cylinder is formed ; this is then grasped by its extremities by the thumb and index finger of the left hand ; the free extremity of the strip is then grasped between the thumb and index finger of the right hand, and by alternate pronation and supination of the right hand the cylinder is revolved and the roller is formed ; the firmness of the roller will depend upon the amount of tension which is kept upon the free extremity of the strip during the revolution of the cylinder (Fig. 2). A bandage rolled

BANDAGING.

in the form of a cylinder is called a single or single-headed roller (Fig. 3) ; if rolled from each extremity toward the centre, so that two cylinders are formed joined by the

Fig. 3.

Fig. 4.

Single roller.

Double roller.

central portion of the strip, the double or double-headed roller is formed (Fig. 4).

Double rollers are not much used, and in practice the single roller will be found to be amply sufficient for the application of almost all the bandages employed in surgical dressings.

The free end of the roller-bandage is called the initial extremity ; the end which is enclosed in the centre of the cylinder is its terminal extremity ; and the portion between the extremities the body; a roller has also two surfaces, external and internal.

Dimensions of Bandages. — Bandages vary in length and width according to the purposes for which they are employed, and in practice it will be found that a small variety of bandages will be amply sufficient for the application of the ordinary surgical dressings.

The following list, comprising those most frequently used, will show their dimensions :

Bandages one inch wide, three yards in length, for bandages for the hand, fingers, and toes.

GENERAL RULES FOR BANDAGING. 21

Bandages two inches wide, six yards in length, for head-bandages and for the extremities in children.

Bandages two and a half inches wide, seven yards in length, for bandages of the extremities in adults ; a roller of this size is the one most generally used.

Bandages three inches wide, nine yards in length, for bandages of the thigh, groin, and trunk.

Bandages four inches wide, ten yards in length, for bandages of the trunk.

General Rules for Bandaging. — In applying a roller-bandage, the operator should place the external surface of the free extremity of the roller upon the part, holding it in position with the fingers of the left hand until fixed by a few turns of the roller, the cylinder being held in the right hand by the thumb aud fingers; for thus as the bandage is unwound it rolls into the operator's hand, thereby giving him more control of it ; care should also be taken that the turns are applied smoothly to the surface, and that the pressure exerted by each turn is uniform.

When a bandage is applied to a limb, the surgeon should see that the part is in the position it is to occupy as regards flexion and extension when the dressing is completed, for a bandage applied when the limb is flexed will exert too much pressure when the limb is extended, and then may, by the pressure it exerts, become a matter of discomfort or even of danger to the patient, or if applied to an extended limb it will become uncomfortable upon flexion.

My experience has been that, as a rule, those who have had little experience with the application of the roller-bandage are apt to apply the bandages too tightly, and this may lead to disastrous consequences, gangrene of the extremities having resulted from the too tight application of bandages, especially in the dressing of fractures. Professor Ashhurst, in his clinical teaching, advised students to make use of a larger number of turns of a bandage in securing fracture-dressings rather than to depend upon a few turns too firmly applied — advice which certainly conduces to the safety and comfort of the patient. When the

BANDAGING.

bandage has been completed, the terminal extremity should be secured by a pin or safety-pin applied transversely to the bandage, and if a pin be used its point should be

Fig. 5.

Method of removing a bandage.

buried in the folds of the bandage ; if the bandage be a narrow one, the end may be split and the two tails resulting secured around the part by tying.

Fig. 6.

Bandage-scissors.

Removal of Bandages. — In removing a bandage, the folds should be carefully gathered up in a loose mass as

VARIETIES OF BANDAGES. 23

the bandage is unwound, the mass being transferred rapidly from one hand to the other, thus facilitating its removal and preventing the part from becoming entangled in its loops (Fig. 5). If it is desirable to cut the bandage to remove it, the use of scissors made for this purpose will be found most satisfactory (Fig. 6).

VARIETIES OF BANDAGES.

Circular Bandage. — This bandage consists of a few circular turns around a part, each turn covering accurately the preceding turn. This variety of bandage may be used to retain a dressing to a limited portion of the head, neck, or limbs, to make compression upon the veins of the arm before performing venesection, or to secure a compress to control venous hemorrhage (Fig. 11).

Oblique Bandage. — In this form of bandage the turns are carried obliquely over the part, leaving uncovered spaces between the successive turns (Fig. 7). It cannot

Fig. 7.

Oblique bandage.

be applied with much firmness on account of the swelling of the uncovered portions of skin between the turns of the bandage, and its principal use is for the application of temporary dressings, such as wet dressings which may require frequent removal.

Spiral Bandage. — In this bandage the turns are carried

BANDAGING.

around the part in a spiral direction, each turn overlapping a portion of the preceding one, usually one-third or one-half; it may be applied as an ascending spiral (Fig. 8)

Fig. 8.

Ascending spiral bandage.

or as a descending spiral (Fig. 9). This bandage may be used to cover a part which does not increase rapidly in diameter ; for instance, the abdomen, chest, or arm.

Fig. 9.

Descending spiral bandage.

Spiral Reversed Bandage. — This bandage is a spiral bandage, but differs from the ordinary spiral bandage in having its turns folded back or reversed as it ascends a part the diameter of which gradually increases. By its use, it is possible to cover by spiral turns a part conical in shape, so as to make equable pressure upon all parts of the surface. The reverses are made as follows : After

) name from the turns being applied so as to form a figure-of-eight. This method of application is made use of in the Barton's bandage, the bandages of the knee and elbow, and many other bandages.

Recurrent bandage.

Recurrent Bandage. — This bandage derives its name from the fact that the roller after covering a certain part of the surface is reflected and brought back to the point of starting ; it is then reversed and carried toward the opposite point, and this manipulation is continued until the part is covered by these recurrent turns, which are then secured by a few circular turns (Fig. 13). This is the bandage usually employed in the dressing of stumps after amputation.

Compound Bandages.

These bandages are usually formed of several pieces of muslin or other material, sewed or pinned together, and are employed to fulfil some special indication in the application of dressings to particular parts of the body. The most useful of the compound bandages are the T-bandages and the many-tailed bandages.

BANDAGING.

T-bandage. — The single T-bandage consists of a horizontal band to which is attached, about its middle, another having a vertical direction ; the horizontal piece should be about twice the length of the vertical piece (Fig. 14). The

Single T-bandage.

single T-bandage may be used to retain dressings to the head, the horizontal piece being passed around the head from the occiput to the forehead, the vertical piece being

Single T-bandage for chest.

passed over the head and secured to the horizontal piece, the shape and width of the two pieces being varied according to the indications. In applying dressings to the anal

COMPO UND BAND A GES.

region or perineum, or in securing a catheter in a perineal wound, the single T-bandage will be found most useful. In applying a T-bandage for this purpose, the body of the bandage is placed over the spine, just above the pelvis, and the horizontal portion is tied around the abdomen. The free extremity is split into two tails for about two-thirds of its length, and is carried over the anal region and brought up between the thighs, the terminal strips passing one on each side of the scrotum and being secured to the horizontal strip in front. The single T-bandage may be

T-bandage of groin.

variously modified according to the indications which are to be met ; for instance, in applying a dressing to the breasts the horizontal strip passing around the chest may be made ten or twelve inches in width ; the vertical strip, two inches in width, passes from the back over the shoulder and is secured to the horizontal strip in front (Fig. 15). For the groin, a piece of muslin six inches

BANDAGING.

wide at its base and thirty inches long is sewed to a horizontal strip of muslin one and a half yards long and two inches in width. It may be applied as in Fig. 16 to hold a dressing to this part.

Double T -bandage. — The double T-bandage differs from the single bandage in having two vertical strips attached to the horizontal strip, and it may be used for much the same purposes as the single T-bandage (Fig. 17).

Double T-bandage.

It may be conveniently used for retaining dressings to the chest, breast, or abdomen ; when used for this purpose the horizontal portion should be from eight to twelve inches wide and long enough to pass one and a quarter times about the chest ; two vertical strips, two inches wide and twenty inches long, should be attached to the horizontal strip a short distance apart near its middle. In applying this bandage to the chest, the horizontal strip is placed around the chest so that the vertical strips occupy a position on either side of the spine ; the overlapping end of the horizontal portion is secured by pins or safety-pins, and the vertical strips are next carried one over either shoulder and secured to the other portion of the bandage in front of the chest (Fig. 18).

The double T-bandage may also be used to secure dress-

COMPOUND BANDAGES.

ings to the nose, in which event the strips should be quite narrow, about one inch in width, and should be applied as shown in Fig. 1 9.

Double T-bandage of cbest.

Double T-bandage of nose.

Many-tailed Bandages or Slings. — These bandages are prepared from pieces of muslin of various lengths and breadths, which are split at each extremity into two, three, or more tails up to within a few inches of their centres, their width and length being regulated by the part of the body to which they are to be applied.

The four-tailed bandage may be found useful as a temporary dressing in cases of fracture of the jaw, or to hold dressings to the chin. It may be prepared by taking a portion of a roller-bandage three inches wide and one yard in length, and splitting each extremity up to within two inches of the centre ; it is then applied as seen in Fig. 20.

The four-tailed bandage may also be used to retail* dressings to the scalp, and may be prepared by taking a piece of muslin one yard and a quarter long and six or eight inches in width, splitting it at each extremity into two tails within six inches of the centre; it may then be applied as seen in Fig. 21.

The four-tailed bandage may also be used in the tern-

BANDAGING.

porary dressing of fractures of the clavicle, the body of the bandage being placed upon the elbow of the injured

•f

Four-tailed bandage of chin.

Four-tailed bandage of head.

side, two tails passing around the body, fixing the arm to the side, and two tails passing over the sound shoulder.

Many-tailed bandage of abdomen.

Many-tailed Bandage of Abdomen. — This bandage may also be used for holding dressings in contact with the abdomen or trunk, and is the bandage which most surgeons

COMPOUND BANDAGES.

employ to hold the dressings to a laparotomy wound, and to give support to the abdominal walls after this operaation. In preparing this bandage, a strip of muslin or

Dressing secured by strips of plaster and safety-pins. Fig. 24.

Dressing for laparatomy wound held by strips of plaster and tapes.

flannel, one and a half yards in length and eighteen to twenty inches in width, is required ; the extremities may be split on each side to within six inches of the centre so as to form a four- or six-tailed bandage. In applying this bandage to the abdomen, the body is placed upon the patient's back and the tails are brought around the abdomen and overlap each other, and when sufficiently firmly 3

BANDAGING.

drawn to make the desired amount of pressure they are secured by means of safety-pins (Fig. 22).

Many surgeons prefer to hold the dressings to a laparotomy wound in place by three or four broad straps of adhesive plaster passing from the back across the abdomen. These are cut in the centre at the first dressing, and the ends turned back to remove the dressings. When the new dressing is applied, it is secured in place by holding together the cut ends of the straps by safety-pins (Fig. 23).

When the dressing of a laparotomy wound requires frequent changing, it will be found convenient to hold the dressing in place by straps of adhesive plaster nine inches in length and two inches in width. Three or four such strips are attached to the back on each side of the abdomen, and to the free end of each strap is attached a short piece of tape. When the dressing is applied to the wound, the ends of the corresponding tapes are tied together and the dressing is secured in place (Fig. 24).