for the same purposes for wliich these materials are used.
Rubber Tissue. — Tiiis material consists of rubber run out into very
thin sheets ; it has a glazed surface, is very pliable and strong, and forms
a cheap and satisfactory substitute for oiled silk, being employed for the
same purposes. In the moist method of antisejitic dressing it may be
used in place of the macintosh.
Parchment Paper. — This is a very tough pa]ier material which can
be soaked in a solution of corrosive sublimate or carbolic acid without
becoming so much softened as to tear upon handling, and it is employed
for the same purposes as macintosh.
Protective. — Protective is employed to prevent the wound from
being irritated by antiseptic sub.stances ^\•ith which the gauze is imj)reg-
nated or by its irregular surface. Various materials are emjiloyed as
protectives, the principal requirement being that the tissue can Ije readily
rendered aseptic and does not ab.sorb any irritating materials from the
dressings. The protective first employed by Lister, which is still gen-
erally used, is ])repared by coating oiled silk with copal varnish, and when
this is dry a mixture of 1 part of dextrin, two parts of powdered starch,
and 16 parts of a 1 : 20 carbolic solution is rubbed over its surface.
Rubber tissue may l)e employed very satisfactorily as a substitute for this
protective.
Macintosh. — This consists of cotton cloth with a thin layer of india-
rubber spread on one side. It is emjiloyed in antiseptic dressings as a
layer outside of the gauze, and .should be applied with the rubber surface
toward the wound, to prevent the entrance of air, and to allow the serum
from the wound to permeate the gauze and not to soak directly through
the dressings.
MATERIALS USED AV SURGICAL DRESSINGS. 69
Rubber Dam. — This is a thin pure rubber tissue, and, as it has no
cloth surface hke macintosli, it is cleaned and sterilized with greater
facility. It is used in applying the moist method of dressing to cover
the gauze dressings, and is attached to a drainage-tube in abdominal
wounds to shut off the opening of the (h'ainage-tul)e from tlic abdominal
wound. Before being used it shoukl l)e washed with soap and water and
rinsed, and then placed in a solution of carbolic acid lor a short time.
Gauze Dressings. — The most convenient and cheapest material for
wound-dressing is a sheer material known to the trade as cheese- or
tobacco-cloth. By reason of having a very open mesh it absorbs well
either the materials with which it is prepared or the discharges from the
wound. It can be readily obtained anywiiere, is inexpensive, and is soft
and pliable, so that it is a comfortable dressing to the patient.
In the preparation of cheese-cloth to form the gauze dressings it is
first placed in a vessel and covered with water, to which is added wash-
ing soda or lye, and is boiled ; the soda or lye is added to remove any
oily matters wiiicli the cheese-cloth contains, thus making it more absorb-
ent. After the cheese-cloth has been boiled it is washed and passed
through a clothes-wringer, and is then impregnated with some of the
various substances which are used to render it antiseptic, or it may be
dried and baked in an oven and be used as the simple sterilized gauze.
Compresses. — Compresses are prepared by folding pieces of linen or
flannel upon themselves, so as to form masses of various sizes; oakum
or cotton may also be used for compresses. Compresses are employed
to make pressure over localized portions of the body, as in the treat-
ment of fractures, or to make pressure on vessels for the control of
hemorrhage.
Tampon. — A tampon is a form of compress which is employed in
cavities to make pressure, to control hemorrhage, or to apply various
medicines to the surface of a cavity. Tamjions made to control hemor-
rhage are generally made of strips of bichloride or iodoform gauze or
of pledgets of bichloride cotton. In applying this the strips of cotton
are packed into the cavity, and when the cavity is full a compress is
applied superficially and held in place by a l)andage.
A f/lyccriii hiiiipnii, employed as an application to the os uteri, may be
made by pouring half an ounce of glycerin on a piece of cotton or wool
and then turning up the ends and securing them by a string, one end of
which is allowed to remain long to hang from the vagina to facilitate its
removal.
Tent. — This consists of a small portion of lint, oakum, or nuislin
rolled into a ('(jnical shape, and is employed to keeji wounds open and
to facilitate the escape of discharges. This dressing is not much em-
ployed at the present time, its use being largely superseded by the
drainage-tube. •
Retractors. — Retractors are made by taking a piece of muslin four
inches wide and twelve to eighteen inches in length, and splitting it as
far as the centre, thus making a two-tailed retractor (Fig. 80). A three-
tailed retractor is made by making two splits in the fabric (Fig. 81).
Plasters. — The varieties of jilasters which arc most commonl}' em-
ployed in surgical dressings are adhedve or resin plaster, isinglass plaster,
rubScr adhesive plaster, and soap plaster.
70
MINOR SURGERY.
Resin P/asfcr. — This ])laster, which is inachinc-sprcad, is one of the
most \vi(lelv-('iii])iov('cl plasters in suriiical (h'cssintrs : tiic spread surface
is covered with a layer of tissue-paper, which shoukl l)e removed before
Fig. 80.
Fig. 81.
mil
Two-tailed retractor.
Three-tailed retractor.
it is used, and the strips should be cut lengthwise from the roll, as the
cloth upon which it is spread .stretches more transversely than in a
longitudinal direction. When heated and ap])lied to the surface it holds
firmly ; it is prepared for application by applying the uusjircad side to a
vessel containing hot water, or it may be jiassed rapidly through the
flame of an alcohol lamp.
This is the jtlaster generally used in making the extension apparatus
for the treatment of fractures, f )r strapping the chest in fractures of the
ribs and sternum, for strajiping the pelvis in cases of fractures of the
pelvic bones, or for strapping the breast, the testicle, ulcers, or joints.
Rubber Adhexivc Plaster. — This plaster is made by spreading a
preparation of india-rnblier on muslin, and has the advantage over the
ordinary resin plaster that it adheres without the ap])licatioii of heat.
It is employed for the same ])ur|)oses as resin pla.ster, but when applied
continuously to the skin it is apt to produce a certain amount of irrita-
tion, and for this reason, when it is to be applied for some time, as in
the case of an extension a])])aratus, it is not so comfortable a dressing as
that made from resin plaster.
Isinglas.^ Planter. — This jilaster, which is made by spreading a solu-
tion of isinglass upon silk or muslin, will be found the most useful dress-
ing in the treatment of superficial wounds. It is made to adhere to the
surface by moi.stening it, and when used in the treatment of W(innds it
should be moi.stened with an anti.septic solution : it is in this way ren-
I
MATERIALS USED IX SURGICAL DRESSISGS.
71
dered aseptic, and may he used with safety in connection with otlier
aseptic dressings. The best Ibrni of this plaster is spread on muslin,
and Avhen properly applied adheres as firmly and possesses as much
strength as the ordinary resin plaster.
Before using any of these plasters, if the part to which they are to
be applied contains hairs, these should be shaved ofl', otherwise traction
upon these, if tiie plaster is used for tlie purjiosc of extension, or in its
removal, will cause the patient discomlbrt or pain.
Soap Plaster. — This plaster for surgical purposes is prepared by spread-
ing emplai^trum f!npo)i>s upon kid or chamois. It has little adhesive power,
and is used simply to give support to parts or to protect salient portions
of the skeleton from pressure. It is found a most useful dressing when
applied over the sacrum in cases of threatened beil-sores, and may be
applied for the same purpose to other parts of the both' where pressure-
sores are apt to occur.
In the treatment of joints a well-moulded soap-plaster splint secured
by a bandage will often be found a most efficient dressing, and in the
treatment of fractures the comfort of the jiaticnt is often materially
increased by ap])lying a piece of soaj) plaster over the liony prominences,
upon which the splints, even when well padded, are apt to make an undue
amount of pressure.
Strapping. — The ajiplication of pressiu'e to parts li}- means of strips
of plaster tirmly applied is a procedure often emphned in surgical
practice.
Strappiiu/ the Testicle. — In strapping the testicle strijis of resin
plaster are usually employed ; a dozen or more strips, three-quarters
of an inch in width and twelve inches in length, will be required.
The scrotum should be first washed and shaved, and the surgeon then
draws the skin over the affected organ tense by passing the thumb and
finger around the scrt)tum at its
upper portion, making circular con-
striction. A strip of plaster which
has been heated is passed in a circu-
lar manner around the skin of the
.scrotum above the organ, and is
tightly drawn and secured ; this iso-
lates tiie [tart and prevents the other
strips from slii)])ing. Strips are now
employed in a longitudinal direction,
the first strip being fastened to the circular strip and carried over the
most prominent jiortion of the testicle (Fig. 82), and is then carried
back to the circular strip and fastened. A number of these strips are
a])plicd in an imljricatcd manner until the skin is covered in (Fig. Si*),
and the dressing is completed by passing transverse strips around the
scrotum from its lowest portion to the circular strip ; care should be
taken to see that no portion of the skin is left uncovered.
Stra])])ing the testicle is em|)loyed with advantage in the subacute
stage of orchitis or epididymitis, and is a useful means of applying
pressure to the scrotum after tlic injection treatment of hydrocele. As
the swelling of the testicle diminishes the strips become loose and the
parts require restrapping.
Fig. 82.
Straiii>ing the testicle (SiiiithK
MINOR SURGERY.
Ptriipping the breast (Smith).
Strapping the Brcn><f. — In stnipping the breast, strips of resin plaster,
two inches in widtii and long cnongli to pass from tiie opjiosite sliouldcr
under the breast to tiie point of starting, are required. In applying it
the end of the strip is placed on tlie spine of the scapula on the side
op])osite the diseased breast, is carried for-
ward over the shoulder and oblirpiely down-
ward under the breast and axilla, and then
over the back to tlie point of starting ; the
next strip is applied in the same direction,
overlapping about one-third of the pre-
vious strip (Fig. 83) ; tliese oblique strips
arc a])plicd in an iml)ricatcd manner until
a sulKcicnt numl)er have been used to cover
in tlie breast, or the obli(jue strips may be
alternated with circular strips passing from
the steriuim over the breast to the spine.
A sufficient number of strijis are used to
cover the breast and make firm compression upon it.
Strapping the breast in this manner will be found a satisfactory
method of treatment in chronic intlannnatory conditions of the breast,
where it is of ad\'antage to support the breast and make comj^ression
at the same time ; it has the advantage over the use of a bandage to
support and compress the breast in that it does not interfere with the
chest motions upon the opposite side of the body.
Strapping the Vhcxt. — To straj) one-half of the chest strips of resin
plaster, two and a half inches in width and long enough to extend from
the spine to the median line of the sternum — eighteen to twenty inches
in length — will be required. One extremity of a strip is placed upon
the spine opposite the lower portion of the chest ;
it is then carried over the chest, and its other
extremity is fixed upon the skin in tlie median
line of the sternum. Strips are next ap]ilicd from
below upward in the same manner, each strip
overlapping one-third of the preceding one, until
the axillary fold is reached (Fig. 84) ; a second
layer of strips may be applied over the first if
additional fixation is desired, or a few oblique
stri])s may also be employed. Adhesive strips
applied in this manner very materially limit the
motion of the chest-wall ujjon the afl'ected side,
and are frequently employed in the treatment of
fractures and dislocations of the ribs, in contusions of the chest, and in
cases of plastic pleurisy wliere the motions of the chest-walls are
extremely painful to the jiatient.
Strapping of Ulcers. — To strap ulcers of the leg, strips of resin
plaster, two inches wide and long enough to extend two-thirds around
the limb, are required. Tlie ulcer should he tlK)roughly cleansed and
the skin surrounding it should be well dried : the first strip, being
heated, is applied obliquely to the long axis of the leg about two inches
below the ulcer, and is carried two-thirds around the limb ; another
strip is applied to a corresponding point of the skin on the opposite
Fig. 84.
strapping the chest.
STRAPPING.
73
side of the limb and is carried obliquely ovei- the limb, crossing the
first strip in the median line, and is carried two-thirds of the way
around the leg ; alternate strips are then applied until the ulcer is
covered in, and the strips are carried several inches above the ulcer
(Fig. 85). Care should be taken tliat the strips arc so applied as
Fig. 85.
Strappiii',' ulcer of leer (Liston).
not to meet or cover the entire circumference of the liml), as by so
doing injurious circular compression may result. Chronic ulcers upon
otlier portions of the body may be strapped in the same manner.
The strapping of leg ulcers is usually reinforced by the application
of a spiral reversed or spica bandage of the lower extremity. Strap-
ping of ulcers of the leg in the manner described will be found a most
satisfactory method of treating chronic ulcers in this location in patients
who have to work during the course of treatment : the strips need only
be removed at intervals of a M'eek, and, if well applictl, the dressing is
generally a comfortable one to the patient.
Slrappinr/ of Joints. — Strips of resin ])laster, two inches in width
and long enougli to extend two-thirds around tiie joint, are required.
The first strip is applied aV)out two inches below tlie joint, and strips are
then applied aljove tliis, each strip covering in two-thirds of the pre-
ceding one until the joint is covered in and the strips extend a few
inches above the joint.
The ankle-joint is strapped liv taking strips of resin plaster one and
a half inches in width : the first strip is placed over the heel, and its
ends are brouglu forward until they meet over tiu dorsum of the foot;
a second strip encircles the fodt and secures the ends of the first strip.
The strips are alternately applied, each strip covering one-half of the
previous strip until the foot and ankle are covered.
Strapping of joints will be found a satisfactory dressing in the treat-
ment of sprains of joints in their ciironic state.
Strappiii;/ of a ( 'arhioicle. — To strap a carliuncle strijis of resin plaster
one to one and a half inches in width are required. These strips are
74 BIINOR SURGERY.
ajiplit'd lo the iiiar<>;in of tlic swelling, iind are laid on coiicontrically
until all except the central ])ortion are covered in; if a nunil)er of open-
ings exist, the strips are so ])laced us not to cover these. iStrapping
applied in this maimer in the treatment of carbuncle is often a com-
fortable dressing to the patient, and at the same time the concentric
pressure favors the extrusion of the sloughs.
Poultices. — -This form of dressing was formerly iiuicli (•iii])loyed in
the treatment of local intlamniatory conditions, or in wounds, as a means
of applying heat and moisture to the part at the same time, and, although
the use of poultices is now very much restricted since the introduction
of the antiseptic method of wound-treatment, there are still conditions
in which their emi)loymcnt is both useful and judicious.
Poultices are often eniployed with advantage in inflannnatorv atT'ec-
tions of the chest and aliddininal organs ; and in intlanunatury affections
of the joints and of Ixme their action, combined with rest, is often most
satisfactory ; in cases of gangrene their employment hastens the sejiara-
tion of the sloughs. They constitute a form of dressing which conduces
much to the comfort of the patient in cases of deep suppuration by their
relaxing effect upon the tissues, and their previous use does not prevent
the surgeon from using all antiseptic precautions in the opening and
drainage of these abscesses and the employment of antiseptic dressings
in their subsequent treatment.
Flaxseed Poultice. — This poidtice is prepared by adding a little
warm water to ground flaxseed, and then adding bf)iling water and
stirring it until the resulting mixture is of the consistency of thick
mush. A piece of muslin is next taken, which is cut a little larger
than the intended poultice, and this is laid u|)on the surface of a table,
and the poultice mass is spread evenly ujion it from a quarter to a half
inch in thickness with a spatula or knife ; a margin of the muslin of
one and a half inches is left, which is turned over after the poultice is
spread, and serves to prevent it from esca])ing around the edges when
applied. The surface of the poultice may be evenly spread over with a
little olive oil or may be covered with a layer of thin gauze to prevent
the mass from adhering to the skin. It is next applied to the surface
of the skin, and is covered with a piece of oiled silk, rubber tissue, or
waxed paper, and is held in position by a bandage or a binder.
Bread Poultice. — This poultice is prejiared from stale wheaten bread,
the crusts being discarded and the crimibs only being used ; this is
moistened with boiling water and allowed to soak for ar few moments,
when the excessive moisture is jioured off and the mass is spread upon a
piece of muslin or linen, as before described.
Starch Poultice. — This poultice is prejiared by mixing starch with
cold water until a smooth, creamy fluid results ; Ixiiling water is then
added, and it is heated until it becomes clear and it has about the same
consistencv as the starch used for laundry purposes. When suflicieutly
cold it is spread upon muslin and apjilied to the part, and co^â– ered with
oiled silk or waxed paper. This variety of poultice is principally used
in cases of disease of the skin, especially those of the scalp accompanied
by the formation of scales or crusts, to facilitate their removal and to
furnish a clean surface for the ajiplication of ointments or wet dressings.
Charcoal Poultice. — In prej)aring this poultice flaxseed meal and
POULTICES. 7o
powdered charcoal are mixed together, and Ijy addinsi' lioiliiig- water a
pouhicc mass is produced whicli is spread ni>nn muslin as previously
detailed. It is better to use animal cliarcoal in making tiiis poultice, as
it has greater deodorizing power than the vegetalde charcoal. Thi.s
poultice is used as an application to gangrenous parts, as it possesses
marked deodorizing properties.
Fermenting Poultice. — Tliis poultice may he prepared l)y adding yeast,
two tablespoonfnls, to a mixture of flaxseed with liot water, making a
thin poultice mass, and allowing it to stand for a i'ev\- hours in a warm
place ; it rises and becomes light, and is then spread upon muslin and
applied as required. A few ounces of porter or a piece of yeast-cake
mav be used as a substitute for the yeast in preparing this poultice ;
charcoal mav also be added to it to increase its disinfectant power. This
poultice was formerly, and is still, used as an application to gangrenous
parts to hasten their separation and to diminisii tlie odor arising from the
necrosed tissues.
Oatuin, Poultice. — This poultice is prepared by soaking a mass of
loosely-picked oakum in hot water, wringing it out, and covering it
with a layer of cheese-cloth or antiseptic gauze. It is next applied to
the part and covered with oiled silk or rubber tissue, and held in place
by a bandage; it has a large cai)acity fir the absorption of discharges.
It may be wrung out in a warm liicidoride or carbolic solution, and thus
form an antiseptic poultice.
Hot Fomentations. — Hot fomentations are employed to keep up the
vitality of parts which have been subjected to injury, as seen in severe
contusions or lacerations resulting from railway or machinery accidents ;
also to combat inflammatory action. Flannel cloths, several layers in
thickness, or surgical lint, sliould l)c soaked in water having a tempera-
ture of 120° F. ; these are wrung out and placed over the part and covered
with M'axed paper or rubber tissue ; a second cloth should be placed in
hot water, ready to apply as soon as the first-apjilied cloth begins to
cool, and so by continuously reapplying them the part is kept constantly
covered l)y a hot dressing. The use of these hot fomentations may in
many cases have to be continued for hours before the desired result is
obtained. Hot compjresses applied in this manner are frequently em-
])lovcd in treating inflammatory conditions of the eye, and are also of
the greatest service in keeping up tiie vitality of parts which have been
sul)jected to severe injury interfering with tlieir blood-supply. The
writer has fretpiently seen contused limbs, which were cold and seemed
to be doomed to gangrene by reason of tlieir diminished blood-su])])ly,
have their temperature and circulation restored by the patient and per-
sistent use of this dressing. After the vitality of such a part is restored
it should be covered with cotton and a flannel bandage alid surrounded
by hot-water bags or hot-water cans.
Irrigation. — This mav lie accom]>lished by allowing tlie irrigating
fluid to come directly in contact witli tlie wound or inflamed part, whicli
is known as immediede irrigation, or by allowing the cold or warm fluid
to pass through rubber tubes which are iu contact with or surround the
part ; the latter method is known as mediate irrigcdion.
Immediate Irrigation. — In ajiplying immediate irrigation in the treat-
ment of wounds or in inflammatory conditions a funnel-shaped can with
76
Ml yon snidERY.
â– A stop-cock at tlic bottom, or a bucket, is suspended over tlic part at a
distance of a few inclies (Fig. 86), or a jar with a skein of thread <ir
Fig. 86.
Apparatus for continuous irrigation (Esmarch).
lam]>-\vick arranged to act as a siphon may be emjihiyed (Fig. 87). The
can or jar is hlletl with water, and this is allowed to fall, drop by drop,
Fig. 8".
Irrigating apparatus (Ericliscn).
n}X)n the part to be irrigated, which should lie placed upon a piece of
rubber sheeting so arranged as to allow the water to run oif in a reeep-
IRRIGATION.
I I
tacle, so as to prevent the wetting of the patient's bed. Tlie water
employed may be either cold or warm, and this is decided by tlu' indica-
tions in special cases, and if it is desired to make use of antiseptic irri-
gation, the water is impregnated with carbolic acid or bichloride of mer-
cury, a 1 : 5000 to 1 : 10,000 bichloride solution, or a 1 : 60 carbolic acid
solution is frecjuently employed with good results.
Antiseptic irrigation employed in this manner will be found a most
useful method in treating lacerated and contused wounds of the extremi-
ties in which the vitality of the tissues are impaired, and in such cases
warm water should be preferred to cold water, the temperature being
from 100° to 110'^ F. Under the use of warm irrigation it is surprising
to see how tissues apparently devitalized regain their vitality. The
absence of tension from the non-introduction of sutures or firm dressings,
and the warmth and moisture kept constantly in contact with the wound
by this methotl of treatment, are the important factors in the attainment
of this favorable result.
3Iediatc In-igafinv. — In ajiplying mediate irrigation cold or warm
water is passed through a rubber tube in contact with the part. A
flexible tube of india-rubber half an inch in diameter, with thin walls,
and sixteen or twenty feet in length, is applied to the limb like a sjiiral