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LIST OF AUTHORS IN VOL. TT.
DENNIS, FREDERIC S., M. D. ;
FORWOOD, WILLIAM H., M.D.;
FOWLER, GEORGE R., M. D. ;
GERRISH, FREDERIC H., M. D. ;
GIBNEY, VIRGIL P., M.D.;
KEEN, W. W., M.D., LL.D ;
PARK, ROSWELL, M. D. ;
ROBERTS, JOHN B., M.D.;
SENN, NICHOLAS. M. D., LL.D.;
STIMSON, LEWIS A., M.D.;
WHARTON, HENRY R., M. D.
SYSTEM
SURGERY.
f
EDITED BY
FREDEKIC S. DENNIS, M.D.,
/â–
PKOFESSOR OF THE PRINCIPLES AND PRACTICE OF SURGERY, BELLF.VUE HOSPITAL MEDICAL COLLEGE;
Visiting Surgeon to the Bellevce and St. Vincent Hospitals ; Consulting Surgeon to
THE Harlem Hospital and the Montefiore Home, New York: President of
THE Amerkan Surgical Association ; Graduate of the Royal
College of Surgeon.?, London: Member of the German
Congress of Surgeons, Berlin.
ASSISTED BY
JOHN S. BILLINGS, M. D.;
LL.D. Edin. and Harv. ; D. C. L. OxoN. ; Deputy Surgeon-general U. S. A.
Vol. II.
MLNOR, PLASTIC, AND MILITARY SURGERY-DISEASES OF THE
BONES-ORTHOP/EDIC SURGERY- ANEURYSM-SURGERY
OF THE ARTERIES, VEINS AND LYMPHATICS -DIS-
EASES AND INJURIES OF THE HEAD-SURGERY
OF THE SPINE-SURGERY OF THE NERVES.
PROFUSELY ILLUSTRATED.
PHILADELPHIA:
LEA BROTHERS & CO.
1895.
Entered according to Act of Congress in the year 1895, by
LEA BROTHERS & CO.,
in the OiEce of the Librarian of Congress, at Washington. All rights reserved.
WESTCOTT & THOMSON, WILLIAM J DORNAN.
ELECTROTYPERS. PHILADA. PRINTER, PHILAOA.
CONTENTS OF VOLUME II.
PAGE
MINOR SURGERY 17
By Heney R. Wharton, M. IX, Demonstrator of Surgery and Lecturer on
the Surgical Diseases of C'liildren, Univei'sity of Pennsylvania, PhilaJelpliia.
PLASTIC SURGERY 137
By' George R. Fowler, M. I)., Surgeon to St. Mary's and tlie Metliodist
Episcopal Hospitals ; Examiner in Surgery to tlie State Medical Exam-
ining Board, Brooklyn.
.MILITARY vSURGERY AND THE CARE OF THE WOUNDED ON THE
BATTLE-FIELD 191
By AVilliam H. Forwood, M. D., Lieutenant-Colonel and Deputy Snrgeon-
(ieneral, U. S. A. ; Professor of Surgery in the .\rniy Medical School,
Wasliington, D. C.
DISEASES OF THE BONES 219
B\- Nichola.s Sexx, il. D., LL.D., Professor of tlie Practice of Surgery,
Rush Medical College ; Professor of Surgery, Chicago Polyclinic ; Surgeon
to the Presl)yterian and Emergency Hospitals, Chicago.
ORTHOPAEDIC SURGERY 265
By' Virgil P. Gibney, M. D., Surgeon-in-Chief to the Hospital for Rup-
tured and Crippled; (Jrthopa'dic Surgeon to the Nursery and Child's Hos-
pital, New York.
ANEURYSM 367
1!y Lewis A. Stijison, M. D., Professor of Surgery, University df the City of
New York ; Surgeon to the Bellevue and New York Hospitals, New York.
SURGERY OF THE ARTERIES AND VEINS (EXCLUSIVE OF
ANEURYSM) 435
By Frederic S. Dennis, .M. D., Professor of the Principles and Practice of
Surgery, Bellevue Hospital Medical College ; Surgeon to the Bellevue and
St. Vincent llosiiitals. New York.
7
8 CONTENTS.
PAG IC
SURGERY OF THE LYMPHATIC SYSTEM 461
By Fhedkric 11. (iioniusn, M.D., Consulting Surgeon, Maine (ienenil Hos-
pital, Portland, Me. ; Professor of Anatomy, Kowdoin College.
DISEASES AND INJURIES OV THE HEAD 497
By Roswkll Pauk, M. D., Professor of Surgery, Medical Department Uni-
versity of Bufiiilo ; Surgeon to the Buflalo General Hospital, and Consulting
Surgeon to the Fitch .\ccident Hospital, Buflalo, N. Y.
THE SURGERY OF THE SPINE 787
By W. W. Kken, M. D., LL.D., Professor of the Principles of Surgery and
of Clinical Surgery, Jeflerson Medical College, Philadelphia.
SURGERY OF THE NERVES 867
By John B. Rokertr, M. D., Professor of the Principles and Practice of
Surger\-, Woman's Medical College, Philadelphia.
MINOR SURGERY.
By henry R. WHARTON, M. D.
Bandages.
Baxdages constitute one of tlie most widely used and important
suri>ie:il dressings : they are very generally employed to hold dressings
in coiitaet with wounds, to make pressure, and to secure sj)lints in place
in the treatment of fractures and dislocations, liandages may lie pre-
pared of various materials, such as nuislin (l)leached or unlileaehed),
linen, crinoline, flannel, cheese- or tobacco-cloth, rubber sheeting ; and
of these the most widely used is the bandage made from unbleached
muslin, because of its cheapness. Flannel, from its elasticity, is some-
times used, but its employment for bandages is now generally limited
to its use in dressings after operative work u]>on the eye and for the
primary roller in the api)lication of plaster-of- Paris dressings.
Bandages are either nimple, when composed of one piece of material,
such as the ordinary roller bandage, or romponnd, when prepared of one
or more ])ieces secured together and adapted by size and shape to pecu-
liar objects. Every practitioner should be perfectly familiar with the
general rules of bandaging, and proficient in the ap])licati(in of the roller
bandage, for a well-applied bandage adds much to tiie comfort of the
patient, and the metht)d of its apjjlication often secures for the physician
the confidence both of the patient and his friends, while, on the other
hand, a badlv-a])])licd bandage is ajit to be uncomfortable and insecure.
The Roller Bandage. — Tlie roller bandagi' consists of a stri]) of
some one of the materials previously mentioned, of vnriaiilc length and
widtii, whicii, for case of application, is rolled into a cylindrical form.
A bandage rolled into the form of a cylinder is called a single or single-
headed roller ; if rolled from each extremity toward the centre, so that
two cylinders are formed, joined by a central strip, a double or double-
headed roller is formed. Double rollers are not nuich used at the
present time, and in practice the single roller will be found to be amply
sufflcient for the apjilication of almost all the bandages employed in
surgical dressings. The free end of the roller bandage is called the
initial e.iiremiti/ ; the end which is enclosed in the centre of the cylinder
is the fcnniiial e.vfirmifi/ ; and the portion between the extremities, /Ar
bocli/. The roller liandage has two surfaces, e.rfcnutJ and infernal. The
material conimoiilv cm|)loyed for the roller l)andage is unbleached
muslin, although for sjx'cial purposes linen, flannel, rubber sheeting,
crinoline, or cheese-cloth may be used. It is important tiiat the roller
bandage should consist of one piece, free from seams or selvage, for if
made from a number of pieces .sewed together, or if it contains creases
Vol. II.— 2 17
18
MINOR SURGERY.
or sc'lvajit', it cannot be so neatly a])])liwl and it is not so coinf'ortalilc to
tiie ])atiiMit, as it is apt to leave creases u|)on the skin. In ju'eparinj;
the ordinarv nuislin Inindage the material is torn into stri])s varvinu; in
length and width according to the portion of the body to wliich it is
to be applied, and it is then rolled into a cylinder, either liy hand (ir
by a niacliine constrncted for the ]>ur])ose.
Every |)ractitioner siionld l)e able to roll a baiidauc liv hand, for
in practice the medical attendant may at any moment l)e calle<l npon
to roll a bandage in order to apply
*«*■1- dressing, and the art is acquired by
a little practice. To roll a bandage
by hand the strij) should be folded
at one extremity several times until
a small cylinder is formed ; this is
then grasped by its extremities by the
tlunnb and index finger of the left
hand ; the free extremity of the strip
is then grasped by the thnmi> and
index finger of the right hand, and
by alternating pronation and supina-
tion of the right hand the cylinder is
revolved and the roller is formed : the
firmness of the roller will de])end
upon the amount of tension which is
kept upon the free extremity of the
strip during the revolution ot the cylinder (Fig. 1).
infx a banda<ro by hand.
Dimensions of Bandages.
Bandages vary in length and width according to the jnirposes for
Mhich they are em|)l()yed, and in practice it will be found that a
small variety of bandages will be amply sufficient for the a])jilication
of all the ordinarv surgical dressings. The following list comprises
those most frequently used, and shows their dimensions :
Bandage one inch in width, three vards in lenirth, for bandaae for
hand, fingers, and toes.
Bandage two inclu's wide, six yards in length, for head bandages and
for the extremities in children.
IJandage 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.
Bandage three inches wide, nine yards in length, for bandages of the
thigh, groin and trunk.
I>andage 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 I'Xtremity of the roller on the ]>art, and hold it in
position with the fingers of the left hand until fixed f)y a few turns of
the roller, the evliud<r being held in the right hand, so that, as the
BASDAGES.
19
bandage is unwound it rolls in the operator's hand, thereby giving him
more eontrol of it ; care should also be taken that the turns are applietl
smoothly to the surface and tiiat the pressure exerted l)y each turn is
uniform. When a bandage is apjdied to a limb the surgeon should see
that the limb is in the position that it should occu])y, as regards flexion
and extension, when the dressing is completed, for a bandage applied
when the limb is flexed M'ill exert too much pressure when the limb is
extended, and may thus 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. Those who have little cxjierience in the
application of roller bandages are apt to apply their bandages too
tightly, and this may lead to disastrous consequences, especially in the
dressing of fractures. When the liandage has been completed the
terminal extremity should be secured l)y a pin or safety-pin applied
transversely to the bandage, and if a pin he used its point should be
buried in the folds of the bandage ; or if the bandage be a narrow one
the end may be split, and the two tails resulting may be secured
around the part by tying. In removing a bandage the folds should be
carefully gathered u]) into a loose mass as the bandage is unwound, the
mass being transferred rapidly from one hand to the other, thus fiicil-
FiG. 2.
Method nf rrin(i\'inL' a li:in(l:iL;e'.
itiiting its removal and preventing the part becoming entangled in its
loops (Fig. 2).
Yahii^ties of Baxdages.
The Circular Bandage. — This bandage consists of a few circular
turns around a part, each turn covering accurately the preceding turn
(Fig. 429, h). This variety of bandage may jje used to retain a dress-
ing to a portion of the head, neck, or limbs, or to hold a compress upon
the veins of the extremities in the case of wounds or before or after
performing venesection.
20
MI soil SURGERY.
The Oblique Bandag-e. — In this ionii of bandaging the turns are
carried obliquely over the parts, leaving uncovered spaces between the
oblique bandage.
successive turns (Fig. 3). Its principal use is for securing temporary
dressings.
The Spiral Bandage. — In this bandage the turns are carried around
the jwrts in a spiral direction, each turn overlapping the previous one
usually one-third or one-half; it may be applied as an ascending spiral
Fic. 4.
A5C^'nllin^• spirul b;inihige.
(Fig. 4) or as a descending .spiral (Fig. 5). This bandage may be
Duscendinj; spiral bandage.
used to cover a part which does not increase too rajjidly in diameter ; for
instance, the abdomen, chest, or arm.
The Spiral Reversed Bandage. — Tiiis bandage is a spiral bandage,
l)ut differs from the ordinary spiral bandage in having its turns folded
back or reversed as it a.scends a part the diameter of which gradually
increases. By its u.se it is possible to cover by spiral turns a i)art conical
in shape, so as to make equable pressure ujion all parts of the surface.
BANDAGES.
21
The reverses are made as follows : After fixiiig the initial extremity of
tlie roller, as the part increases in diameter the handaye is earried off a
little oi)li(iuely to the axis of the limh from three to six inehes ; the index
finger or thumb of the disengaged hand is placed npon the body of the
bandage to keep it securely in jilace upon the limb ; the hand holding
the roller is carried a little toward the limb to slacken the unwound jjor-
tion of tile bandage, and by changing the ])iisition of the hand holding
the l)andage from extreme supination to pronation the reverse is made
(Fig. ()). Care should be taken not to attempt to make the reverse
while the bandage is tense, for by so
doing the bandage is twisted into a Fig. 6.
cord which is unsightly and uncom-
fortable to tiie patient, instead of
forming a closely - fitting reverse.
The reverse shouhl l>e eomj)leted
before the bandage is carried aroinid
the limb, and when it has been com-
pleted the bandage should be slightly
tightened, so as to conform to tlic
part accurately. The reverses should
be in line, to have the bandage pre-
sent a good appearance, and care
should be taken that the reverses
are not made over salient parts of
the skeleton, for if they occupy such
position they cause creases of the
skin and become uncomfortable to
the patient. To make reverses neatly
and have them in line requires skill and practice ; a \xell-applied spiral
reversed bandage is a test of a competent bandager.
The Spica Bandage. — When tiie turns of tlie roller cross each other
in the form of the (ireek letter Iniii/xhi, leaving the jjrevious turn about
one-third uncovered, the bandage is known as a spica bandage (Fig. 7).
f iii;ikiiiu' rt'\'iTsrs.
Fig.
Spica bandage.
Circular bandage.
The spica bandages are especially serviceable as a means of retaining
surgical dressings u])ou the sliouldcrs, groin, or foot.
Figure-of-8 Bandage. — Tiiis bandage receives its name from the
turns being apjilied so as to fijrm the figure of 8. This method of appli-
cation is made use of in the Barton bandage, the bandages of the knee
and ell)ow, and manv other bandages.
22
MINOR SURGERY.
â– ^k;. S.
KecviiTfiit liiinilat^u.
Fig. 9.
Recurrent Bandage. — Tliis l)an(laij:o derives its name from the fact
that the roller alter cuvering a certain portion of the surface is reflected
and brought back to the point of starting ;
it is then reversed and carried toward tlie
opposite point ; and this manipulation is
continued until the part is covered in
liy these recurrent turns, which are tlicn
scrnred liv a few circular turns passed
:iround the part (Fig. 8). This is the
bandage usually employed in the dress-
ings of stumps.
C'oJiPOUND Bandages. — The.se band-
ages 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 appli-
cation of dressings to })artieular parts of
the body. The most u.seful of the com-
])ound liandages are the T-liandages and
the many-tailed bandages.
T-Bandages. — The single T-bandage consists of a horizontal band,
to which is attached, about its middle, another band in a vertical direc-
tion : the horizontal piece should be twice the length of the vertical piece
(Fig. 9). The single T-l)andage
may be used to retain dressings to
the head, the horizontal jiicce being
passed around the head from the
occiput to the forehead, the vertical
piece being 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 region or perineum, or
in securing a catheter in a ]ierineal
wound, the single T-bandage will
be found most useful. In ap])lying
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 stri])s passing one on each side of the
scrotum and l)cing secured to the horizontal strip in front. The single
T-bandage may be variously modified act'ording 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 ; a vertical strip, two inches in width, passes from the
back over the shoulder and is .sccTired to the horizontal strip in front
(Fig. 10). It may also lie modified to ajiply dressings to particular
parts of the body ; for instance, to the groin, in which case a piece of
muslin si.K inches wide at its base and thirtv-si.x inches long is sewed
Single T-ljaiidage.
BANDAGES.
23
to a liorizontal piece of musliu one and
inches in widtli. It may
be ap])lied a^ in Fig. 11 to
hold dressings to tliis part,
Double T-bandag-e. —
Tlie ddulilc T-liaiidagc dif-
fers from tiie single T-
Fio. 10.
half yards long and two
Fio. 11.
Siiiglr T liiiidiL'i' for chest.
T-bandage of groin.
bandage in having two vertical strips attached to the horizontal strip,
and it may be used for much the .sanu' ])nrpo.se as the single T-bandage.
It may be conveniently used for retaining dressings to the chest, breasts,
or abdomen ; when used for this purpose the horizontal portion should
be from eight to ten inches wide, and long enough to pass one and a
ipiarter times about the chest or abdomen ; two vertical strips, two inches
wide and twenty inches long, should be atta<'licd to the horizontal strip
a short distance apart, near its middle. In apj)lying this bandage to the
chest the horizontal strip is passed around the chest, so that the vertical
strips occupy a position on either side of the spine ; the overlapping end
Fir;. 12.
Fig. 13.
Double T-bandage of chest.
Double T-bandage of nose.
of the horizontal portion is secured by jiins or .safety-pins, and the ver-
tical .strips are next carried, one over ea<-h shduldcr, and secured to the
other portion of the bandage in front of the chest (Fig. 12). The
24
Mixon sri:<;i:i:y.
(Idiil)!*' T-l);ui(l;ijj(' may alwo hu iisi'd to st'ciire (lrcs.*iiigs to tlic nose,
ill which event the strips should Ijc (jnite narrow, about one inch in
wi(hii, and should he applied as shown in Fig. 13.
Many-tailed Bandages or Slings. — These haiiflages are ])re])arcd
from jiieces of muslin, which arc sjilit at each e.xtremity into two, three,
or more tails u|) to within a few inches of their centres, their width and
length lieing regulated hy the part of the liody to which thev are to 1)0
applied.
The foiu-tailcd 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 sjilitting each cxti'cniity U]i to within two
inches of the centre, and it is then ajijilieil as seen in Fig. 14. A four-
FiG. 15.
Four*tnilerl bnnrlaKe of chin.
Four-tailed bandage of head.
tailed bandage may also be used to retain dressings to the scalp, and can
be jirepared by taking a jiiece of muslin one and a quarter yards long
and si.x or eight inches in width, splitting it at each e.xtremity into two
tails within six inches of the centre ; it may then be applied as seen in
Fig. 15. A four-tailed bandage may akso be used in the temporary
dressing of fracture of the clavicle ; the body of the baixlage being jilaced
U])oii tlu' elbow of the injured side, the two tails should be jiassed around
the body and tied, ti.xing the arm to the side ; two tails sli<iiild jiass over
the sound shoulder, anil their ends should be secured by tying.
The many-tailed bandage may also be used for holding dressings in
contact with the abdomen or trunk, and this is the bandage which many
surgeons em])loy to hold dressings to a laparotomy wound and to give
su]>port to the abdominal walls after this operation. In jirejiaring this
bandage a .-^trip of muslin or flannel, one and a half yards in length and
eighteen to twenty inches in width, is reipiired ; the extremities may be
split so as to form an eight-tailed bandage. In applying this bandage
to the abdomen the body of the bandage is placed upon the patient's
back, and the tails are brought around the abdomen and overlap each
other, and when sufficiently firmly drawn to make the desired amount
of pressure they are secured by means of safety-pins.
BANDAGES.
•Zo
Handkerchief Bandages. — Tlic use (if liandkerchiefs or square
pieces of imislin f)r tlic teiiiporarv dressings of woiimls, fracture, or <lis-
location was advucateJ many years ago by il. Mayor, a Swiss surgeon,
who wrote an extensive woi"k upon tliis subject. He employed a liand-
kerchief or a square piece of muslin, and by various modifications in the
application of tiiese developed a number of very ingenious bandages in
which the handkerchief or .s(iuare may be used as an obloiif/, made by
folding tlie sipiare once or twice on itself; as a triawjle, made by bring-
ing together the diagonal angles of the s((uare ; or as a cravat or cord.
The names of the various handkerciiief bandages are derived from
the shaj)e of tiie handkerchiefs used and the parts to which they are to be
applied ; the names ;dso serve as guides to their ap])lication. It is to be
remembered tliat the base of tiie triangle or the body of the cravat is to
be placed upon the jtDrtion tiie designation of which forms the first
portion of the name of the i)andage ; thus, in the fronto-occipital triangle
the shape of the handkerchief is given, and we know that the base of
the triangle is to be applied to the foreliead and then passed to the occi-
put. In using the cravat the same rule applies ; tiius, in the bis-axillary
cravat the body of the cravat is jilaeed in tiie axilla of tiie affected side,
tlie extremities cross over tiie ccirresponding slioulder, and are carried
over the chest, one before, the otlier beiiind, to the axilla of the opposite
side, where they are secured.
The following are a few of tlie many ingenious bandages devised by
Mayor as substitutes fiir the roller bandaire. It is well to bear in mind
Vlii. K).
OcciiJitu-frontal triaugle.
this system of dressing : the occasion may occur in wliicii otiier means
of bandaging could not be obtained, and the application of handkerchief
bandages might answer a useful ])ur])ose for teiii]iorary dressings, i)ut
they will never take the place of the roller iiaiulage, which can be
26
Mixni: srn(ii:r;y.
applied witli miicli orcater nicety mid exactness and certainly presents a
mucli neater appearance.
The (knpito-frontal Triangle. — To apply this liaMilkcrchicf, place the
base of the triangle on the nape of the neck and hrinj;- the apex forward
over tile head, aliowinii' it to liant:: down in front; knot the extremities
around the forehead, and tiii'ii ii]) the apex over tiie knot and jiin it
to tile l)ody (Fig. Ki).
Menfn-verUco-occipitai Cravat. — In ajiplying this handker»'hief the
middle of the base of the cravat is jilaced under tlie chin, the extrem-
ities are then carried to the vertex of tlic skull and are crossed at that
point, and the ends are carried down over the jiarietal region and secured
by a knot at the occiput (Fig. 17). Another nietluid of applying this
Fig. 17.
Mento-vertico-ocoipital cravat.
cravat consists in placing the base of the cravat under the chin and
carrying the extremities over the vertex, crossing them at that point,
then carrying them downward to the occiput, crossing them at this
point, and pa.ssing them forward around the front portion of the chin
and securing the ends by a knot. The turns of the cravat correspond
exactly to tlu)se of the Barton bandage for the head, and this dressing,
as well as the mento-vertico-occiiiitul cravat previously described, mav
be used as a temporary dressing to secure fixation in cases of fracture
of the upper or lower jaw (Fig. 18).