be covered with a soft, closely-fitting woven seamless sliirt without arms,
I'atient suspended for application of
but with shoulder-straps to hold it in position, or an ordinary woven
iindersiiirt may be emjiloyed ; one or two folded towels or a pad of cot-
ton wrappeil in a tcjwel is next placed over the abdomen between the
60 MIXOn SURGERy.
shirt and skin, called by Pnif. Sayrc tlic (Iinncr-|)ad, and is intended to
leave space for the distention of the abdomen after eatinj;-. Small jiads
of raw cotton may also be placed over the anterior iliac s])ines, and in
the case of females a pad of cotton wrapped in a hanillverchief may be
placed over each mammary jjland. The ])atient should next be sus-
pended by the apjiaratus consistinn- of a collar and arm-pieces attached
to a cross-lxir (Fig. 70), wliicli is attaciied by a cord and j)nlley to a
tripod. If this a])])aratus is not at hand, a very satisfactory substitute
may be made by folding two towels into cravats and tying together the
ends so as to make two loops, one of which is placed in each axilla ; a
bar of wood two and a half feet in length is next taken, and the loops
are secured to the ends of this by stout cords or handkerchiefs ; a Barton's
bandage is next aj)plied to the head, and a strip of bandage is passed
under the turns which cross the vertex and secured to tlu' middle of the
cross-bar. The bar is next suspended by a cord passed through a pulley
or ring which may be attached to the sill of a door if the ordinary tripod
cannot be obtained. The patient should be raised by the apparatus until
the toes only arc in contact with the floor, and the extension should not
be carried to the point which makes it uncomfortable to the patient
Some surgeons omit making extension in applying jilaster-ot-Paris
bandage, using only the head-gear for extension and timitting the exten-
sion from the arm-piece. The shirt should be drawn downward from
the hips by an assistant and held in place until a few turns of the band-
age have been aj)plied. The jilaster bandage having been soaked and
squeezed, a turn should be made around the body just above the pelvis;
it should then be carried downward, and several turns should be made
around the body below the iliac S])incs, and from this point it should be
made to ascend gradually by s})iral turns until the axillary line is reached.
The turns sht)uld lie ap])lied smoothly and not too tightly. After two or
three layers of turns ha\e been applied the surgeon may rub some moist
plaster upon their surface if he desires to use fewer bandages. These
turns are repeated until a bandage of the desired thickness is applied,
and the surface of the dressing may be finished by rubbing it over with
moistened plaster. The jacket for a child will usually require about
three or four bandages of the dimensions given ; for an adult six or
eight bandages will be required.
The patient should be kept suspended until the bandage has set,
usually from ten to fifteen minutes, and then should be carefully lifted,
so as not to bend the spine, and placed on his liack upon a mattress
until the dressing becomes perfectly hard. The dinner-pad (and mam-
maiy pads, if they have been used) should next be removed. In
apj)lving this dressing strijis of zinc or tin may be placed between the
layers of bandage if it is desired to give more strength to the jacket.
Great care must be exercised lest too much extension is applied and a
serious accident occur.
Application of Jury-maM hi/ rncans of Plaster of Paris. — In disease
of the spine involving the cervical and upper dorsal region an ordinary
plaster-of- Paris jacket is not satisfactory, and in such cases the jury-mast
is employed in connection with the plaster jacket. In applying the
jury-mast the same steps are taken in the preparation of the patient
as in applyino; the plaster-ot-Paris jacket, witli the exception of exten-
sion, which need not lie used.
After the application of tliree or four layers of the plaster-of-Paris
bandage to the body an apparatus made of
two bars of metal having two jierforated strips
of zinc attached to tiiem a few inches apart,
which partly encircle tlic body, is applied and
held in position by turns of the plaster band-
age. The perpendicular bars have at tlieir
upper part a slot into which the lower end
of the jury-mast fits and is secured by a
screw ; to the upper part of this is attached a
movable cross-bar, attaciied to which are fastened
the straps of the collar from wiiich the head is
suspended (Fig. 72).
The Bararian Dres-^im/. — In apjilying this
dressing, which is sometimes employed in the
treatment of fractures, take two pieces of canton
flannel the length of the part to be enclosed and
more than wide enough to envelop its circum-
ference. In applying this dressing to the leg
these pieces should be cut so as to correspond to
the outline of the leg and posterior portion of the
foot. These pieces should bo jjlaced one over the
other, and sewed together in the middle line, the
seam corresponding to the back of the leg. The leg and foot are then
placed upon this, and the inner layer of flannel is brought up in front
of the leg and over the dorsum of the foot and made fast with pins or
strips (Fig. 73). Plaster of Paris is next mixed with water and made
Head-support and jury-mast.
into a paste, which is rubbed thickly over the flannel next to the surface
of the limb until a sufficient thickness is obtained ; the outer layer of
flannel is then brought up about the leg and moulded to its surfiicc by
the hands. A loosely-applied bandage may now be used to hold the
dressing in place until the jilaster has set.
When it is necessary to in.spect the parts tlie turns of the bandage
62 MI son svrjiERY.
art' cut, :m(l upon s(']):initini; the layers of Haiiiicl the two halves can be
turned aside, tlie seam at the l)ael< aetinji' as a liintic. T"|)ou reaj)j)lying
the S])lints to tlie h^g- the dressuij; may Ix' retained in ])osition by a band-
age or liy one or two strips of muslin.
Moulded Plaster Splints. — It is sometimes found difficult to apply the
ordinary plaster dressing to parts irregular in shape, and at tlie same
time to have a sj)lint whieh can be removed with ease. To aecomjtlish
tiiis purjxise moulded splints of plaster may be made by cutting a ])aper
pattern of the ])art to be covered in, and then cutting pieces of crinoline
to conform to this pattern ; eight or ten pieces will usually form a splint
of sufficient thickness. One of these pieces of crinoline is laid u))on a
table and dry plaster is rubbed into its meshes; another is laid u])on this
and ])laster is applied to it in the same way ; and so on until all the
pieces have been placed in position, one over the other, with ])laster
rubbed well into the meshes. The dressing is then folded up and dipped
into water, squeezed out, and moulded to the part and held in ])osition,
by the turns of a bandage, until it sets. The edges should slightly
overlap each other, and in applying it a strip of waxed paper may be
])laced under the overlajtping edges to prevent its adiiesion to the sur-
face below, and this fiieilitates its removal. Splints prepared in this
way can l)e renio\'cd \\ith ease, and are often of service in cases A\'here
it is desirable to inspect the parts frequently. The author has employed
with advantage such splints in making fixation of the hijj-joint in cases
of coxalgia, and also for the same purpase in affections of other joints.
Splints upon being reapjilied are secured by a few strips of bandage or
by a roller bandage.
Trapping Plaxtcr-nf-Parh Bandages. — It is often necessary to make a
trap or fenestrum in tlie plaster-of-Paris bandage which has been applied
to a part where there is a wound which requires inspection or dressing.
In applying the bandage it is well to make some jn-ovision whereby the
])laster-of- Paris dressing over the seat of the wound may lie cut away.
To accomplish this, before applying a plaster-of-Paris bandage a com-
press of lint or gauze should be placed over the wound, which, when the
Plaster-of-Paris bandage trapped (Esmarch).
dressing is completed, forms a projection on its surface indicating the
position of the wound, and also allows the surgeon to cut awav the
plaster dressing without injury to the skin below (Fig. 74). These traps
HARDEMXG BANDAGES. (i3
may be cut out with a knife after tiie bandage has partially set or after
it has beeouie hard. In a]>|)lyini;- a plaster-of-Paris dressing in cases
of conipotuul fracture and alter osteotomy it is always well to make ])ro-
vision for trapping the bandage if it should become necessary, although
in the vast majority of cases it does not need to be done.
Reinorliif/ Flash'r-of-Paris from the Hands. — One objection to the use
of plaster-of-Paris dressings is the difticidty of removing the plaster
from tile hands of the surgeon, and the harsh condition in which the
skin of the hand is left after its removal. If, however, the hands are
washed in a solution of carbonate of sodium — a tablespoonful to a l)asin
of water — the plaster will be I'eadily removed, and the skin will be left
in a soft and comfortable condition.
Ecmovnl nf tlic Plaxicr-of-Parh Bandage. — The removal of the plas-
ter-of-Paris bandage is sometimes a matter of ditiieulty, ])artieularly if
it has to be removed before the })arts below have become consoliilated,
as it may disarrange them and cause the patient pain if it is not accom-
plished witiiont nnich force.
When the bandage is applied to get a cast of the part, or in the
treatment of fractures where it may be desiralde to remo\e it within a
few days, a strip of sheet lead one inch in width is first placed over the
flannel bandage, and is allowed to ])rojeet at each end beyond the dress-
ing ; after the plaster bandage has been applied and before it has quite
set it can be readily cut through upon this strip with a knife with(.)ut
injury to the parts below, and the cast can be removed as soon as it is
firm. It may also be removed by means of a saw devised for this pur-
Saw fur removing plaster-of-Paris bandage.
pose (Fig. 75), or by strong cutting shears of various kinds (Fig. 70),
or a line may be painted over the dressing with hydrochloric acid or
Sliears for eutting plaster-nf-raris V)andage.
vinegar, which softens the plaster so that it can be readily cut through
with a knife. Dr. William B. Hopkins has devised a vertebrated metal
chain which is applied to the part before the ])laster is aj)plied, and
removed when the bandage has set, leaving a hollow longitudinal ridge
which can be cut through or divided with a rasp. The use of the saw
or shears is the most satisfactory method to remove these dressings ; the
only caution to be exercised is to use them carefully as the final layers
of the bandatre are divided, to avoid wounding the skin.
64 MiyOR SURGERY.
Z^fies of the Plash r-of- Parity DrcxKinr/s. — Plaster-of- Paris dressings arc
employed to secure fixation, as ]iriiiiarv or secondary dressings in tiie
treatment of" fVaetures, and for a liki' j)nr|)ose in injuries or diseases of
tlie joints. Tliey are also largely used in the treatment of diseases of
the spinal colunni, and will also he found the most satisfactory dressing
after osteotomy and tenotomy to see^ure immobility and hold the parts in
their corrected positions ; when employed in the dressings of cases after
tenotomy thi'y are generally used for a few weeks until the proper me-
chanical ap])aratus is a))plied.
The Starched Bandage. — -In tlie application of this bandage starch
is first mixed with water until a thick creamy mixture results ; to this
is added boiling water until a clear mucilaginous licpiid is produced ; if
too thin, it can be made thicker by heating for a few minutes. The
part to be dressed is first covered with a flannel roller, and over this a
few layers of cheese-cloth or criuoline, which has been shrunken, are
applied : the starch is then smeared or rultlied with the hand evenly into
the meshes of tlie material, and the part is again covered with a layer
of turns of the bandage, and the starch is again applied ; this manipula-
tion is continued until a dressing of the desired thickness is produced.
Strips of pasteboard may be applied between the layers of the bandage
to give additional strength to the dressing if desired. It requires from
twenty-four to thirty-six hours for the starched bandage to become dry
and thoroughly set, which is a decided disadvantage in its employment.
A starched bandage may be removed in the Siime way in which the
plaster-of-Paris dressing is removed. Before the introduction of the
plaster-of-Paris dressing the starched bandage was nuicli emjjloyed as a
means of fixation in the treatment of fractures and injuries of the joints.
It may be used in such cases, l)ut possesses no advantage over the former
dressing, and has the disadvantage of setting much less promptly.
Gum-and-chalk Bandage. — In the application of this dressing
equal parts of jiowdered gum arable and precipitated chalk are mixed
with boiling water until a mass of the consistence of thick cream re-
sults. This is apjilied to the cheese-cloth or crinoline bandage in the
same manner as tiie starch in the application of the starched bandage:
it has the advantage over the latter dressing of setting more promptly,
five or six hours only being required for it to become hard. It may be
employed for the same purpose as the starched or plaster-of Paris band-
Silicate-of-Potassium or Sodium Bandage. — In the application of
tiiis bandage, after the flannel roller and .several layers of cheese-cloth
or crinoline bandage have been ap])lied to the part, the surface of the
latter is coated with silicate of sodium or potassium applied by means
of a brush ; then a second layer of crinoline bandage is applied and
treated in the same manner, and this manipulation is continued until a
bandage of the desired thickness is j)rodnccd. It requires twenty-four
hours for this dressing to become firm. In removing the silicate band-
age it may V)c first softened by soaking it in warm water, and it then
can be readily cut with scissors.
In applying either the starched bandage or the silicate-of-potassium
bandage care should be taken to use cheese-cloth or crinoline which has
been shrunken by being moistened and allowed to dry before being em-
plovt'd ; otherwise dangerous compression of the jiart may occnr if the
bandage has l>een firmly applied and shrinks after its application.
The ParaflBn Bandage. — Paraffin, which melts at from 105° to 120°
F., is employed in the application of a fixed dressing. The limb being
covered bv a fiannel roller, a vessel containing paraffin is placed in a
basin of boiling water; as the bandage, which may be either of flannel,
cheese-cloth, or crinoline, is unwound, it is passed through the melted
paraffin and applied to the part, and the turns are repeated until a
dressing of sufficient thickness results, and the surface may be brushed
over with melted paraffin. This dressing sets very rapidly, being quite
firm in frt)m five to ten minutes. It possesses the ad\antage over the
other fixed dressings in that it does ntit absorb discharges and become
offensive, and for this reason it was formerly recommended in the forma-
tion of a fixation splint in the treatment of compi:)und fractures.
Glue or Glue-and-Oxide-of-zinc Bandages. — Glue or glue com-
bined with oxide of zinc has been employed in the preparation of fixed
dressings, but possesses no advantage over those previously mentioned.
In the application of this bandage glue which has been dissolved in
boiling water is brushed over the surface of a crinoline roller applied to
the part, or there may be added to the solution of glue oxide of zinc.
The glue l)andage becomes hard more promptly than the starched band-
age, but does not form .so strong a dressing as the starched, silicate-of-
sodium, or plaster-of- Paris bandage.
Kavv-hide or Leather Splints for Dressings.
In applying raw-hide or leather sjjlints it is necessary first to apply a
plaster-of- Paris l)andage to the part to which
Fro. 77. the raw-hide dressing is fitted, and as soon
as the jilaster has set it is rcmoN-ed, and a
solid plaster cast is next made by pouring
liquid plaster-of-Paris into the mould thus
obtained. When this has become dry a
piece of raw-hide, which has been soaked
for .some hours in warm water, is moulded
to the cast, and is firmly licld in contact
with it by means of a bandage or liy tacks
until it has become perfectly dry, which
Leather jacket with jiiry-inast.
Vol. U.— 3
Leather splint for cervical caries (Owen).
usually requires several days. It is then removed, and its surl'aee is cov-
ered with several coats of shellac to prevent its al)sorbin<>' moisture from
the skin when applied and changinfr its shape. Eyelets or hooks are
fastened to the edges of the splints, through which strings are j)assed to
secure it in jjlacc.
' Kaw-liiile splints pre])ared in this manner fit the part very accurately
and constitute a very satisfactory dressing for cases of joint disease, and
in the form of leather jackets are often employed in the treatment of
disease of the spine in plac(> of the plaster-of-Paris jacket (Figs. 77,
Binder's-board or Pasteboard Splints. — Binder's hoard, w liich can
be ol)tained in sheets of different thickness, is freipiently em])loycd for
the manufacture of splints. A portion of board of the requisite size and
thickness is dipped in boiling water for a short time, ami when it has
become softened it is remo\-ed and allowed to cool ; a thick layer of
cotton batting is next apj)lied over it, and it is then moulded to the part
and held firmly in jilace by the turns of a roller bandage; in a few
liours it becomes dry and liard.
This material, from its cheapness and the ease with which it is
obtained, is frequently employed to mould splints for the treatment of
fractures, especially in children.
Fig. 79. and for the fixation of joints in
the treatment of acute and chronic
j<iint affections (Fig. 79). A
moulded binder's-board splint is
often employed to fix the ends of
the bones after the excision of a
Porous Felt Splints. — This
material is also emjiloyed for the
manufacture of splints, and is ap-
plied by dipping the material in
hot water and then moulding it to
tlie part ; as it dries it becomes
Hatter's-felt Splints. — Hat-
ter's felt is sometimes employed
for the manufacture of splints or
dressings. It is softened by dip-
ping it in boiling water or heating
/ i' iiiiu '!^^^_ "'^k. '* '" *^''' fl'^'^i^ t)f an alcohol lamp,
* '' ^'^^fc- ^^ j,jjj when soft and plialjle it is
moulded to the part, and as it
cools it again becomes hard.
Gutta-percha Splints. — These
splints or dressings are made from sheets of gutta-percha from one-six-
teenth to one-eighth of an inch in thickness. This material is cut into
the requisite shape, and is prejiared for moulding by immer.sing it in
hot water, when it becomes soft and can be moulded to the surface.
Care should be taken that it is not allowed to become too soft, by too
long immersion, to permit its being conveniently handled.
Moulded binder's-board splints.
MATERIAL^ USED IS SURGICAL DRESSINGS. 67
Materials Used in Surgical Dressings.
Lint. — This material is employed in surgical dressings, and is of two
varieties — the domestic lint, which consists of pieces of old linen or
muslin which have been thoroughly washed or boiled and then dried, or
tlie surgical lint, which is manufactured by machinery and resembles
canton flannel in appearance ; the latter is the best material, as it has a
greater absorbing capacity.
Lint is used as a material on which unctuous preparations are spread
in the dressings of wounds, and is also employed as a material for satu-
rating with the various solutions which are used in wet dressings, such
as lead-water and laudanum, or dilute alcohol. The lint, after being sat-
urated witli these solutions, may be covered with rubber tissue or oiled
silk when a|)j>lied, to prevent too rapid evaporation of the solution. It
is also one of the best materials from which to construct compresses em-
ployed in the treatment of fractures, to control hemorrhage, or to make
pressure for any purpose.
Paper 'Lint.— ~Pap(?r lint, made from wood-pulp, is also employed
in surgical dressings, as it lias great absorbing power for fluids, and it
may l)e used as a substitute for surgical lint in the applicati(jn of wet
Oakum. — Oakum, which is made from old tarred rope, was formerly
much employed for dressing of wounds before the introduction of the
antiseptic method of wound-treatment. From its elasticity it is found to
be an excellent material for padding splints or other surgical appliances.
It is also employed in tlie form of pads to place under patients to I'clieve
jiortions of tlie l)ody from pressure or to absorb discharges which soak
through the dressings. A mass of oakum which has been well teased
out and wrapped in a towel forms an e.Kcellent pillow on which to sup-
port a stump.
The oahuin wfon is highly recommended by Dr. Sayre as a means of
making a direct a])pli<'ation of dressings to sinuses of bone : the oakum
is loosely twisted into a cord and covered witli any ointment desired, and
is passed througii the sinuses in the bone ; the position of the seton is
changed from time to time, fresh ointment being applied before it is
Cotton. — Cotton is now employed in .surgical dres.sing.s, principally as
a material to pad splints or to relieve salient parts of the skeleton from
pressure in the application of splints or bandages ; for instance, in the
application of plaster-of-Paris bandages the bony prominences are gen-
erally covered by small masses of cotton ; it possesses but little absorbent
power unless used in the form of ab.sorbent cotton, and is not much em-
ployed in surgical dressings exee])t for the jiurjioscs mentioned above.
Absorbent Cotton. — This material is prejiared from ortlinarv cotton,
whicli is lioiled with a strong alkali to remove the oily matter which it
contains. When .so prepared it absorbs liquids freely, and for this reason
is largely employed in surgical dressings. A small mass of absorbent
cotton wrapjied on the end of a jirobe or stick is now generally employed
to make applications to wounds, and has taken tlie place of the .sponge
or brush which was formerly employed for this piir])ose. From its
cheapness, after one application it can be thrown away and a new piece
68 MINOR SURGERY.
can be used, and thus tlie dantter of carrying infection from one wound
to another by tlie apj)lieator is al)olisIied. It is largely employed in gyne-
cological practice for making applications to the female genital organs.
When impregnated with various antiseptic substances, such as bi-
<!hloride of mercury, carbolic acid, boric acid, and salicylic acid, absorljent
cotton forms the bichloride, carbolized, borated, and salicylated cotton so
much used in antiseptic dressings.
Jute. — This substance is made from tiie fabric of the Corchorun cap-
sukiris, Mhich, on account of the character of its iibre, possesses liotli
elasticity and absorbent qualities : it has been employed for much the
same purposes as oakum and cotton, such as the padding of .splints, and
is also used as an external absorlx'ut dressing.
"Wood-wool. — Wood-wool, made from wood-pulp, such as is employed
in the manufacture of paper, is also furnished in the siiape of lint, sponges,
and pads, and may be used for the same purposes in .surgical dres.sings,
in place of surgical lint or the ordinary sponges or pads.
Oiled Silk and Muslin. — These materials are employed as an external
covering for moist tlressings to prevent rapid evaporation from the dress-
ings ; they form excellent materials for this purpose, but, as they are
quite expensive, their use is limited.
Waxed or ParaflBn Paper. — This dressing is prepared by jiassing
sheets of tissue-paper through melted wax or paraffin, and then allowing
them to dry for a few minutes. Pajier thus treated forms an excellent
and cheap substitute for oiled silk and oiled muslin, and may be employed