headed bandage (Fig. 98).
The bandaging of the thorax and the abdomen becomes very simple if
a broad bandage is applied in spiral turns. In order that the bandage may
be applied firmly, and especially that it may not become displaced laterally,
it is well to place a few spica turns (figure-of-8 turns) around the shoulder or
the hip. Bandages in the region of the pelvis are mostly applied in spica
THE TREATMENT OF WOUNDS
8i
coxse turns (anterior — for instance, after operations for hernia, on the
bladder, penis, scrotum, etc.). For operations on the anus, the T bandage
is best. It is, moreover, just as practical to use so-called bathing
drawers, which apply themselves well everywhere and which are not
expensive.
Fig. 97. Stellated Bandage
(Stella Dorsi)
Fig,
Bandage of the Thorax
(Quadriga)
The compressive bandage for the female breast can be applied in various
ways : either in several single oblique turns, which pass from the healthy
shoulder below the diseased mamma, and, covering each other in the form
of overlapping turns or in the manner of a testudo, extend to the axilla of
the diseased side ; or else in turns which are applied around the healthy
axilla and allowed to cross each other over the shoulder (Fig. 99). In
arranging the turns of the breast ascending from below upward, the
mamma is not only compressed but also supported {covipressoriuvi et sus-
pejisoriiim niamincB^.
A sjispensoriiini viamrn(B duplex (Fig. 100) is best applied with the
turns of the above described stellated bandage (Fig. 97), to which a few
circular turns around the lower mammarv region are added.
The bilateral compressive bandage for the breast {compressoriuni
mammcB duplex) is made in spica or figure-of-8 turns, which cross each other
in front of the sternum. The bandage is carried from the superior side of
one mammia to the inferior side of the other ; across the back to the
82
SURGICAL TECHNIC
inferior side of the first and to the superior side of the other ; thence across
the back again to the superior side of the first. This process is continued
in such a way that the turns, like a testudo, always approach more and
Fig. 99. Sl'spensoku'm Ma.m.m.e
Fig. icx). Double Si'spensory Mammary
Bandage
more a central point — namely, the nipple. For a firmer fixation of the
bandage, either the final tours are carried around the shoulders or a few
circular turns are added around the thorax.
BANDAGES OF THE LEG
The toes are covered together with a circular bandage, and bandaging
each toe separately is dispensed with.
The stapes (Fig. 10 1), for bandaging the dorsum of
the foot, consists of two or three spiral turns, fastened
by a spica turn carried across the ankle joint. The
spica pedis is applied in the same manner as the spica
manus : to the circular turn over the malleoli are
added three or four circular turns across the dorsum
of the foot. The zvJwle foot can be bandaged very well
by increasing the number of these turns with a broad
bandage — only the heel is left imperfectly covered. If
the heel is also to be well protected, then the foot is
Fig. ioi. Stai-es bandaged in the following manner {involntio pedis): —
THE TREATMENT OF WOUNDS
83
The bandage begins immediately above the toes with a circular turn ;
then follow two or three reversed turns on the dorsum of the foot, next
three spica turns around the dorsum of the foot and the malleoli. Having
arrived closely in front of the ankle joint, the bandage now takes its course
from the plantar surface to the right (of the patient), around the calcaneus
over the Achilles tendon, anteriorly from the left to the right again over
the Achilles tendon, on the left around the calcaneus toward the plantar
surface, anteriorly over the ankle joint,
posteriorly around the heel ; it then
ascends across the malleolus to the leg.
The testudo genu has been de-
scribed above on page 72.
The spica coxae for the hip (Fig.
102) resembles essentially the spica
humeri. After a circular turn around
the upper third of the thigh, there fol-
low three or four spica turns, encir-
cling the pelvis. The crossings may
be placed upon the anterior, lateral, or
posterior region of the hip.
Applied on both sides, this spica
coxcB duplex is the best bandage for
the pelvis. Fig. 102 shows a bilateral Ascending
spica coxae anterior ascendens, on the
right leg — descendens on the left leg.
Bandaging of the whole leg {invohitio TJiedenii — Fig. 103) commences
with the bandaging of the foot described above. Thereupon follows the
bandaging of the leg, by a broader ascending spiral bandage with reversed
Fig. 102.
Descending
Double Anterior Spica for the
Hips
Fig. io'^!. Bandaging the Whole Leg
turns ; of the knee, by a testudo ; of the thigh, by an ascending spiral
bandage with reversed turns ; of the region of the hip joint, by a spica
coxae completed with a few circular turns around the hypogastric region.
84 . SURGICAL TECHNIC
Many of the bandages here described are obsolete, and are used in
practice little or not at all. They can all be very well made use of, how-
ever, in practice work ; and although the application of a moist gauze
bandage is easier than that of a stiff linen one, nevertheless, for exact anti-
septic bandaging, a thorough knowledge of the technique of bandaging is
indispensable.
CLOTH BANDAGES
With linen or cotton (shirting, stouts) of triangular (kerchief) or square
(handkerchief, napkin) form, most dressings may be applied just as well as
with bandages, many even better. For the application of cloths, only little
practice is necessary, since the danger of strangulation and stasis even in a
poorly appHed bandage is less than when gauze bandages are used ; the
cloth bandages are especially suitable for temporary dressings, particularly
when made by laymen who render the first assistance (Samaritan). But
they can also be well employed for bandaging wounds — for instance, for
amputation stumps, for fixation of small dressings, compresses, splints, etc.
Fig. 104. VuN Esmakch's Triangular Cloth
Cloth bandages had already been most favorably mentioned sixty years
ago by Gerdy and Mayor ; but they were forgotten, and were brought into
common use only by the introduction of my triangular cloth (Fig. 104).
This is printed with figures on which the various bandages are illustrated.
By these, the expert obtains a quick survey of what he has learned, while
THE TREATMENT OF WOUNDS
85
Fig. 105. Sailor Knot
an inexperienced person obtains a good object lesson for his action, a lesson
of great advantage, especially to soldiers on the battle-field.
We make a distinction between square cloths and large and small tri-
angular cloths.
The former must consist of square pieces, the sides of which are from 90
to 130 centimeters long. The latter (large triangles) are obtained by an
oblique cut ; by cutting from the point to the middle of the base, they may
be divided again into two halves (small
triangles). A triangular cloth has a
point, two extremities, two small sides,
and one long- side.
For fastening the extremities to-
gether, it is best either to use the sailor
knot (Fig. 105), which holds more se-
curely than Xh-Q, granny s knot (Fig. 106),
or by the use of safety pins.
As can be seen from the pictures
printed upon the cloths, they can be
used for various purposes in different
forms and sizes ; now, as a cloth bandage
folded together from the point to the
base into a long and small cravat ; now,
as an open triangle with a manifold
application of the extremities, by doubhng them, inverting them, tying them
together, or fastening them with safety pins.
On the several parts of the body, the cloths are used in the following
manner : —
For bandages of the head, the following are serviceable : —
I. The triangular head cloth (capitium triangulare — Figs
The middle of this triangular cloth is
applied over the vertex so that the long
side hangs down transversely in front
of the forehead, while the point hangs
down over the neck. Next, the two
extremities are carried across both ears
in a posterior direction and allowed to
cross each other over the occiput and
over the point which hangs down;
thence they are carried again anteriorly
Fig. 106. Granny's Knot
Fig. 107. Triangu-
lar Head Cloth
(Anterior view)
Fig. 108. Triangu-
lar Head Cloth
(Posterior view)
86
SURGICAL TECHNIC
Fn;. 109. Fi'NDA
Bandage for
THE Temporal
Region
Fig. iio. Funda
Bandage for
THE Occiput
and are knotted together over the forehead. Finally, the point hanging
down posteriorly is drawn forcibly downward, turned up over the occiput,
and fastened over the vertex with a safety pin.
2. The funda capitis (Figs. 109, no). This is a square cloth, 60 centi-
meters long and 20 centimeters wide, split on the two small sides like a divided
funda bandage. If the operator desires to
use it in fastening a dressing over the pari-
etal region, he knots the two posterior
extremities below the chin and ties the two
anterior together over the nape of the neck
(Fig. 109). But if the dressing is to be
fastened over the occiput, the anterior ex-
tremities are tied together under the chin
and the posterior over the forehead (Fig.
no). In a similar manner, a funda capitis
is made for the frontal region.
3. The large square head cloth (capitium magnum quadrangulare —
Figs. 111-112). This covers, Hke a hood, not only the skull but also the
whole auricular region, the neck, and the throat. It is, therefore, a very
practical protective dressing in bad and in cold weather.
A large cloth (napkin) about i meter square is folded together diagonally,
so that the long margin of the upper half recedes behind the long margin
of the lower part as much as the width of the hand. In this way, a rectangle
is formed. This is applied to the head of the patient as follows: The mid-
dle line of the cloth cov-
ers the sagittal suture;
the free margin of the
lower surface hangs down
to the tip of the nose ; ^'^^<}. -"^^'1
the margin of the upper
112. Large Square
Head Cloth
surface extends to the
superciliary region; the
narrow margins fold
themselves upon the two
shoulders. Of the four
extremities hanging down anteriorly upon the
breast, first the two exterior are tied together under the chin ; next, the
margin of the lower surface hanging down in front of the eyes is turned
up toward the forehead, and the two inner extremities of the same are
Cloth
THE TREATMENT OF WOUNDS
87
drawn backward over the ears and tied together over the nape of the
neck.
With the triangular cloth folded in the shape of a cravat there can be
very easily formed a frontal bandage, a buccal bandage, and an eye bandage
(Fig. 113).
With two such cloths, also a four-tailed bandage for the chin may be extem-
porized (Fig. 114). This is done by placing the middle of one cloth upon
Fig. 113
Eye Bandage
Fig. 114
FuNDA Bandage
FOR THE Chin
Fig. 115
Cravat or Ker-
chief
Fig. 116
Cravat with in-
serted Pasteboard
the anterior surface of the chin and by tying together the ends over the
nape of the neck, while the other cloth is carried up to the vertex from the
lower surface of the chin.
For fastening the bandage over the neck, the kerchief
is of service (Fig. 115). This is a triangular cloth folded
together in the form of a cravat. If 2^ piece of stijf paste-
board ox leather, etc., is incorporated, the bandage becomes
still more secure, and the head can then be bent toward
the injured side (transverse wounds), provided the maxil-
lary margin of the healthy side has been raised by a suffi-
ciently high insertion (Fig. 116).
For bandages of the arm, we use : —
1. The vincidnm carpi, cross bandage for the hand
(Fig. 117). This is a folded cloth, which is placed around
the metacarpus in spica or figure-of-8 turns. The cross-
ing is made over the place of the injury.
2. The hand cloth, gauntlet (Fig. 118). This is used
for bandaging the whole hand. Upon the middle of the
long side of the unfolded cloth, the flat hand is so applied that the wrist lies
upon the margin, while the fingers correspond with the apex. This apex
Fig. 117. Cross Band-
age FOR the Hand
88
SURGICAL TECHNIC
is turned over the dorsal portion of the hand, the lateral extremities are tied
over the wrist, and the apex is used for covering the knot. Amputation
stumps may be bandaged in the same
way (Fig. 1 19).
3. The elbow cloth. This is applied
folded, and bandages the region of the
elbow joint in circular and spica or
figure-of-8 turns.
4. The shoulder cloth. This is ap-
plied : either folded together in a spica
tour around the shoulder, the ends
being tied in the healthy axilla ; or
unfolded, the. apex upon the shoulder
and the extremities tied together in
the other axilla. In this way, the
brachium (arm) is also covered, and a
restful position is thereby secured. It
is very well to employ this method
after exarticulation of the shoulder
joint (Fig. 120). It is more practical, how-
ever, to use tzvo clotJis, placing one, folded as
a loose sling, around the neck — or around
the neck and the
healthy axilla —
and under this
the other with its
apex unfolded is carried and fastened, while the
extremities are tied around
the brachium (arm) (Figs. 118,
119).
Cloths are most frequently
used to meet the following
indications : —
I. To support the arm {mi-
te II a). The viitella pm^va is a
sUng made of the folded cloth
(Fig. 118). Generally, how-
ever, the cloth is unfolded
{mitella triangidaris). It is Fig. 119. Head Ci.oTii.JJKEAsx Cloth, ShuulderClutu
Fig. 118. SHotTLDKR * i.iiMi, Hand
Cloth, Elbow Cloth, and Sal\ll
Sling
THE TREATMENT OF WOUNDS
89
grasped at the apex and at one extremity. This extremity is carried over
the healthy shoulder, while the apex is carried behind the elbow of the
diseased arm; the arm itself is placed horizontally upon the cloth; the
extremity hanging down is turned upward to the diseased shoulder and
tied together with the other extremity over the neck; finally, the apex
is drawn from behind the elbow and fastened in front of the arm with
a safety pin (Fig. 121). When the shoulder of the diseased side cannot
tolerate any pressure, the two extremities may also be carried over the
healthy shoulder (Fig. 122). If, however, the healthy arm is to remain
entirely free, then the two ends are tied together over the diseased shoulder
(Fig. 123). For a safer and firmer position of the arm — for instance, after
reducing a dislocation of the shoulder, or in case of fracture of the clavicle —
a broad cravat, applied across the mitella, is added ; this presses the arm
against the breast (Fig. 124).
The large square cloth for carrying the arm {mitella quadrmigidaris —
Pig. 125) is applied with a napkin, etc. The ends are fastened with safety
pins, since the knots easily cause pressure, especially over the nape of the
neck.
2. To bandage a fractured clavicle. According to Szymanozvsky this
bandage is made with three cloths; it draws the injured shoulder backward
and upward (Fig. 126).
3. To bandage the trunk. In various ways, bandages for this purpose
can easily be made with several cloths ; e.g. the cingulum pectoris (Fig.
129), Roser s apron bandage (Fig. 127).
4. To bandage the whole chest. For this purpose, the cloth is so applied
that the apex can be carried over the shoulder ; the extremities on both sides
are carried around the thorax to the back, where the three corners are knotted
together (Figs. 119, 130). The back bandage is made by applying the cloth
inverted.
Bandagijig the region of the pelvis (Fig. 131). For this purpose, the
apex of the cloth is carried from in front across the perineum, the extremi-
ties are tied around the hips, and the apex is fastened to them (improvised
bathing drawers).
The cloth for the buttocks is inverted (Fig. 132).
Unnds gauze sash (Fig. 134) consists of two strips, one of which sur-
rounds the hips, while the other, fastened to it, supports the penis and the
scrotum, as if in a bag (suspensorium).
6. To bandage the leg. For this purpose, the following are service-
able : —
90
SURGICAL TECHNIC
Fig. 1 20. Breast Cloth, Siioi-lder
Cloth
Fig. 121. MiTELLA Tkiangilaris
Fig. 122. Other Form of Muklla
Fig. 12^. Cloth for Carrying the Arm
THE TREATMENT OF WOUNDS
91
Fig. 124. MiTELLA Bandage
Fig. 125. Square Cloth for Carrying
THE Arm
a. Posterior view b. Anterior view
Fig. 126. Szymanowsky's Bandage for Fracture of the Clavicle
92
SURGICAL TECHNIC
Fig. 127. Roser's Apron Bandage
FOR THE Chest
Fig. 128. Cloth Bandage for the Lateral
Region uf the Chest
Fig. 129. CiNGULUM Pectoris
Fig. 130. Large Breast Cloth
Anterior view
The same, posterior view, see Fig. 119
THE TREATMENT OF WOUNDS
93
{a) The hip cloth (Fig. 133). This is applied with an unfolded and a
folded cloth, in the same manner as the shoulder cloth and Rosers apron
bandage (Fig. 135).
Fig. 131. Bandage for the Peim^
Fig. 133. Hip Cloth
Fig. 132. Cloth for the Buttocks
Fig. 134. Unna's Gauze Sash
{U) The knee cloth (Fig. 136). This, folded together, is carried around
the region of the joint in a spica or figure-of-8 turn.
94
SURGICAL TECHNIC
Fig. 136. Knee Cloth
Fig. 135. Roser's Apron Band-
age FOR THE Inguinal Region
YiG. 137. Foot Cloth
Fig. 1^8. Mayor's Cloth Bandage for Fracture of the Patella
Fig. 139. Mayor's Cloth Bandage for Fracture of ihk Patella
(c) The patella bandage. T\\\?,'v& w&q,^ for fracture of tJu- patella. It is
made with three cloths according to Mayor; but it is not especially effective,
though very good for instruction on bandaging (Figs. 138-139).
THE TREATMENT OF WOUNDS 95
{d) The foot cloth (Fig. 137). This is applied in the same manner as
the hand cloth described above, by turning the apex over the dorsum of the
foot, while the extremities, crossing each other, are carried over the dorsum
and over the ankle joint.
SPLINTS
Splints are used for the purpose of securing rest for injured limbs,
especially when their bones and joints are diseased or injured. The missing
internal support of the limb is supplied by the splint until the disease or the
injury has been repaired.
These supporting bandages, therefore, must
embrace not only the diseased bone, but also the
two neighboring joints and a portion of the fol-
lowing section of the limb, in order to secure com-
plete rest and immobility for the injured part.
Of the large number of splints formerly used
for the most various purposes, now comparatively
few are in use. The most common are the fol-
lowing : —
I. WOODEN SPLINTS
Simple boards, well padded, are fastened by
means of cloths or bandages to the limb, previ-
ously wrapped with bandages. Figure 140 shows
such a fixation dressing for the broken brachium
(arm). If such splints at their ends are provided
with tijt sockets and joints {von Esmarc/i), any F^°- ^40- Fixation Dressing
. /' ^ PQj^ Tjj£ Broken Arm
desired size can be made by joining these together
(for instance, for the whole leg). This wooden splint, wJiicJi can be taken
apart, can be very easily packed up, and occupies but little space. It is
especially suitable for an extension splint during transportation (see below).
T
Fig. 141
Goocli s flexible wooden splints consist of thin strips of fir (6 millimeters),
cut into parallel strips i centimeter wide by means of light, not perfectly
96
SURGICAL TECHNIC
penetrating, parallel cuts, and glued upon leather or canvas. They are per-
fectly flexible transversely, and perfectly firm longitudinally (Fig. 142).
Fig. 142. Guoch's Flexible Wooden Splints
Through the attached strips of leather, straps with buckles are passed ; these
serve for fastening.
t
ri
Fig. 143. Schnyder's Cloth Splints for the Lower Extremity
Sclmyder s cloth splints consist of thin tablets of flexible walnut
(veneer) from 2 to 2.5 centimeters wide and 3 millimeters thick, sewed
THE TREATMENT OF WOUNDS
97
closely side by side between two pieces of canvas or cotton cloth (Fig.
143)-
Similar is von Esmarch's splint material, which can be cut (Fig. 144). It
consists of two layers of material (stouts, shirting, canvas), between which
Fig. 144. Von Esmarch's Splint Material. (Can be cut)
thick paper strips are placed side by side at intervals of 5 millimeters and
firmly agglutinated with silicious varnish, paste, or glue. This splint material
is very light, can be made rapidly and inexpensively, can be cut with the
scissors, and, rolled up, can be packed away in large quantities, since it
requires but little space. As a temporary splint for transportation, it is
very serviceable.
Stronieyer' s padded strips of wood are very much used for injuries and
diseases of the arm. They consist of light wood padded with cotton and
covered with canvas or some waterproof material. The simple board for
Fig. 145. Stromeyer's Hand Splint
the hand (Fig. 145), to secure perfect rest for the hand and the fingers, is
used everywhere, not only in fractures, but also especially in serious felon,
phlegmonous inflammation, etc.
Nelatons abduction splint (pistol splint) serves for fractures at the lower
â– end of the radius.
98
SURGICAL TECHNIC
First, the hand is fastened securely upon the anterior part of the splint ;
next, the splint is turned so that it comes in close contact with the forearm,
to which it is fastened. The abducted position of the hand draws apart
the two ends of the fracture, which lie one upon the other. The splint for
Fig. 146. Stromeyek's Splint F(.)K the Arm at an (.)BTr.sE Angle
the forearm serves for fractures of the forearm when the elbow joint has to
be held at a right angle ; it is supported by a mitella. The splint for the
arm at an obtuse angle (Fig. 146) is useful in contusions, sprains, inflamma-
tions of the elbow, where ice bags are to be employed, and where the
patient is confined to his bed.
Fig. 147. Roser's Dorsal Splint for Fracture of the Lower End
OF THE Radius
Roser's dorsal splint for fracture of the low^er end of the radius is
applied on the extensor side of the arm ; by a special padding, the dorsal
part of the hand is bent toward the volar; the fingers remain free (Fig.
147)-
Carr' s radius splint has an exca-
vation for the wrist, while the fingers,
which remain free, grasp the trans-
verse bar (Fig. 148).
Clover s radius splints (Fig. 149)
are provided with an excavation for the wrist, and the part for the hand
bent off at an angle.
Carr's Radius Splint
THE TREATMENT OF WOUNDS
99
Jr'iG. 149. CuAER's Radius Splints
The English hollow-moulded splints {Bell^ Pott, Cline) are very neatly
carved and fitted to the contour of the limb ; at their external surface,
Fig. 150. Bell's Hollow-moulded Spljm.^ i- .â– .. iiil LtG
Fig. 151. Bell's Four Splints for the Thigh
leather strips are fastened ; through these are drawn straps provided with
buckles, which serve for fastening the splints to the Hmb. The hollow
lOO
SURGICAL TECHNIC
Fig. 152. \'().N Volkmann's Sipinatiun Si'UNT
Fig. 153. WatsuiN's Splint for Resection of the Knee Joint
Fig. 154. \\atson-Vogt's Splint for Resection of the Knee Joint
Fig. 155. Von Volkmann's Tin Splint
THE TREATMENT OF WOUNDS lOI
internal surface, of course, should be padded. Figure 150 shows two of
Bell's splints for tJie leg. Figure 151 shows iowx splints for t lie thigh ; these
are so applied that a, b, c, d, come to lie on the anterior, the interior, the
posterior, and the external side of the limb respectively.
Vo7t J^//^;/m«;2'i' supination splint (Fig. 152), suitable for all injuries of
the forearm, is a wooden arm splint. The part for the hand is fastened at
a right angle to its surface, so that the hand occupies a position halfway
between pronation and supination.
Von Volkmamis knee splint is a short splint similar to Bell's (Fig. 151,
c)\ it is fastened to the popliteal space in order to prevent the knee joint
from moving after extravasations into the same, and in order to prevent the
pressure of the applied bandages upon the vessels in the popliteal space.
Watson- Vogt's splint for resection of the knee joint (Figs. 153, 154) is
suitable only for cases in which a more frequent change of dressings is