Introduction and Background

A CHAPTER BY “JOHN A. WYETH, M.D, ‘MEMBER OF THE NEW YORK MEDIOAL AND PATHOLOGICAL SOCIETIES, ASSISTANT DEMONSTRATOR, ASSISTANT TO THE CHAIR OF ANATOMY, AND EXAMINER FOR THE FACULTY OF THE BELLEVUE HOSPITAL MEDICAL, COL- LEGE IN THE DEPARTMENTS OF PHYSIOLOGY, CHEMIS- ‘TRY, MATERIA MEDICA, AND ANATOMY. Copraicer. JOHN A. WYETH, M.D. . 1875, Jonw F. Trow & Sox, PRINTERS & BOORBINDERS, 205-213 Kast 12th Street, EW YORK, Nut NAL Rr PREFACE. Ts “Chapter in Minor Surgery,” includes the in- troductory pages of a work on Minor Surgery, upon which the author has been engaged for several years. When completed, that volume is intended to be an in- structor to the young surgeon, teaching by most minute and exact explanations how to become practically ac- quainted with the application and management of the various surgical apparatus. From the countless host of appliances in surgery, he has attempted to select those which his own experience and that of his friends among the older and more emi- nent members of the profession can recommend as most useful. It has been his earnest endeavor, as a teacher in sur- gery, to impress upon his students the fact that it would be through a practical knowledge of the Jittle things of their profession that they would soonest reach the great result—success. The fact that he has been constrained to offer these pages in an unfinished form, in response to a demand from a large number of private students, has encouraged him to believe his efforts have not been fruitless. This book will not be completed until the principal iv PREFACE. hospitals of Europe have been visited, with the special aim of studying and introducing in its pages the most recent improvements and ideas in the department of which it treats. In conclusion, acknowledgment is made for some valuable suggestions in this pamphlet from Hamilton’s Surgery, from which one cut is taken, and from Berk- ley Hill’s Essentials of Bandaging, from which two en- gravings are borrowed. The remaining illustrations were made from sketches from life by the author and Mr. Wright, an artist of merit from this city. 7 226 Fira AVENUE, New Yorx, November 15, 1875. A CHAPTER MINOR SURGERY. How to Make and Apply Bandages. Bandages are made of common cotton cloth, called in the stores unbleached muslin, or domestic. The most suitable length is twelve feet, and the piece of goods should be cut in pieces of this length, the out- side edges torn off, and the cloth torn into strips of proper width. Any loose threads in the raveled edges should be carefully pulled out by hand, and the bandage can then be rolled, either by hand or machine, into a firm, smooth roller. The most convenient width for the bandages, for all parts of the body (except the hand), is two and a half inches. The hand bandages should be between three- quarters and one inch in width. . Methods of Applying Bandages. The various portions of the body may be bandaged by the (1) simple spiral, (2) reverse, (8) figure of 8 turn, 6 A CHAPTER IN MINOR SURGERY. and it is best to become thoroughly acquainted with each of these methods, as all three may be required in bandaging a single extremity. The simple spiral turn is most useful in bandaging those parts of the body where there is no sudden increase in the diameter and volume of the part. It is impracticable under other circumstances. Hold the bandage in the hand most convenient, with the back of the roller toward the limb (see Fig. 1) ; with Fig, 1.—The simple spiral method, the unoccupied hand take the free end of the bandage, lay and hold it upon the inner border of the limb, and A CHAPTER IN MINOR SURGERY. 7 carry the turn by the front to the outer side of the part to be bandaged. Having carried the roller twice around the part to secure it, ascend the limb spirally, leaving about one- third of each turn uncovered by the last. a The reverse turn (Fig. 2) is applied as follows: Fie, 2.—The reverse method. Taking the left arm to be bandaged, hold the roller in the right hand, with its convexity toward the limb, and carry it from the inner or ulnar border, by the front, to the outer or radial border, and thus around the arm by two circular turns to secure the roller. Then having 8 A CHAPTER IN MINOR SURGERY. carried the bandage to the outer side, ascending the limb gradually, lay the thumb of the left hand upon the lower edge of the bandage, press it firmly against the limb to prevent slipping, loosen the roller considerably in the right hand, at the same time turning it one-half turn toward the operator. This process is to be repeat- Fig, 8.—The figare-of-8 method. ed as often as necessary, keeping the reverses well upon the outer border and anterior aspect of the extremity. The figure-of-8 turn. After securing the bandage as heretofore described, ascend the limb sharply, from the inner to the outer border, so that at this outer border A CHAPTER IN MINOR SURGERY. 9 of the limb, the lower edge of the roller shall be two or three inches above the starting-point. Then cairy the roller directly across and behind the limb to the same point on the opposite side; then obliquely downward in front, crossing the ascending turn at a right angle. When the outer border of the limb is again reached, carry the roller behind the extremity, directly across the limb, to the starting-point. (See Fig. 3.) The figure-of-8 method will be found to be the most easily and gracefully applied, and the most generally useful, although the other methods may often be used to advantage. In applying bandages under any conditions, the great- est care must be taken to avoid a greater pressure by one turn of the roller than by another: Disastrous results may occur from euch interference with the venous circulation. Under all circumstances, the bandaging should begin at the extremity and carried toward the. centre. If the patient be not under the influence of an anesthetic, he should be consulted as to whether the bandage was too tight for comfort or not. T£ he is unconscious, the operator must rely upon his own skill and judgment. To Bandage the Hand.—(Fig. 4.) Take a roller between three-fourths and one inch in width, and twelve yards in length. Let the hand to be bandaged be pronated, and commence by taking two or three turns of the roller around the carpus, going from the radial over the back of the wrist to the ulnar side. Having in this manner secured the roller, carry it from the radial side of the wrist obliquely across the dorsum 10 A CHAPTER IN MINOR SURGERY. of the hand to the ulnar border of the root of the little finger, then spirally around the little-tinger two turns to its extremity. Next, return by careful spiral turns to the root of the finger, covering it equally and nicely. Fria, 4.—Hand, thumb, and finger bandage.—The author's modification of the old method. From the radial border of the base of the finger the bandage is carried over the back of the hand to the ul- nar side of the carpus, then under the wrist, by the front, to the radial side, and again over the dorsum of the A CHAPTER IN MINOR SURGERY. ll hand around to the ulnar side of the same finger, repeat- ing the figure-of-8, as before. Two turns are then thrown around the wrist to secure the former bandage, and the roller is carried in the same manner to the re- maining fingers. When the index finger is reached, on account of the great space between its root and the thumb, it is advis- able to make four or five extra figure-of-8 turns around its base, carrying the bandage a little lower with each successive layer toward the base of the thumb. Having reached the thumb, the roller is carried spirally to its extremity, as in the other fingers, but in returning, when the last joint of the thumb is reached, the figure- of-8 turn is commenced at this point and continued un- til the ball of the thumb is completely covered. To Bandage the Arm and Shoulder.—(Fig. 5.) Take a roller two and a half inches wide, and of the usual length (twelve yards), fill the palm of the hand (that remained uncovered by the finger bandage) with cotton batting, and lay the end of the roller parallel with a line drawn from the styloid process of the radius to the metacarpo-phalangeal articulation of the thumb. Then carry the roller obliquely across the dorsum of the hand to the ulnar side of the base of the little finger, then directly across the palm to the space between the thumb and index finger, next obliquely across the back of the hand to the ulnar side of the wrist, then across the wrist to the starting-point. Repeat this figure-of-8 turn two or three times, gradually ascending toward the wrist. Put the limb in the proper position, ¢.¢., with the fore- arm flexed at right angles to the humerus, and folded 12 A CHAPTER IN MINOR SURGERY. toward the front of the body, with the thumb up,* and bandage the limb by either of the three methods here- tofore explained, which may suit the shape of the arm or the taste of the surgeon. Fra, 5.—Plaster-of-Paris dressing in fracture of the humerus, When the axilla is reached, the roller is carried from the inner side by the front, over the point of the shoulder, around the back, and underneath the opposite arm, across the chest to the anterior and outer surface * This position is not allowable in fracture of the olecranon process of ulna, which will be explained further on, A CHAPTER IN MINOR SURGERY. 13 of the humerus, then underneath the arm, making a figure-of-8 turn, one loop of which surrounds the arm, and the other the thorax. These turns are continued, gradually ascending until the root of the neck is reached. It is best to fill the axilla of both arms with cotton bat- ting to prevent chafing, when this dressing is to be worn for any length of time. To Bandage the Toes, Foot, Leg, and Thigh. The toes are bandaged in the same manner as the fingers, except that the great toe is covered by the sim- ple spiral turns, as are the four lesser toes. The start- ing-point is the root of the great toe, going from that point across the top of the foot to the fibular side of the root of the little toe, and then as with the fingers. The toe bandage may be dispensed with by placing cotton batting between and around these members, and extending the foot bandage well out over them to hold the batting in position. The Foot.—(Fig. 6.) The author's method is the only one known to him by which the foot and heel are covered completely by a single roller, without covering first the foot and then the heel, or wice versa. Take a roller of the usual width, from six to eight yards in length. Lay the end of the bandage parallel with the axis of the leg, half-way between the.two mal- leoli in front, and carry the roller by the inner side to the heel, so that the middle of the bandage will be over the centre of the heel’s convexity, and on to the starting- 14 A CHAPTER IN MINOR SURGERY. point. Repeat this turn to secure the roller. Next, make another turn around the ankle, carrying the pos- terior edge of the bandage over the centre of the turn Fia. 6.—The author's single bandage for the heel and foot. that has just preceded it, and make one or two other turns in front of this until the heel is completely cov- ered. The bandage is then carried around the heel in the same direction, so that its anterior border rests on the middle of the first turn, and the roller is carried from the fibular side of the heel across the dorsum of the foot to the tibial side of the great toe. It then travels under the bases of the tocs to the little toe, making a couple of complete turns around the foot at this point, and when the roller has again reached the fibular side of the little toe, it is made to cross obliquely the dorsum of the fvot to the tibial side of the heel, keeping the lower edge of the bandage about a quarter of an inch A CHAPTER IN MINOR SURGERY. 15 above the bottom of the heel. Repeat this figure-of-8 turn, gradually climbing up the foot until the entire foot is thoroughly concealed. It is best to cut with the scissors each turn of the roller about half through just when it crosses the front of the ankle, so that the accn- mulation of the bandage at this point may not interfere with the movements of the ankle-joint. The crossings of the figures-of-8 turns on the dorsum of the foot should be kept a little to the fibular side of the median line. To Bandage the Leg and Thigh—(Fig. 7.) Carry the roller two turns around the leg, just above the ankle, slightly overlapping the upper portion of the foot bandage, beginning on the inner side and going by the front to the outer side. Then cover the entire limb by either of the three methods heretofore explained (the figure-of-8 being the quickest method), until the bandage touches the perineum. Upon reaching this point carry the roller outward and upward, just above the great trochanter, then around the back to the upper border of the opposite ilium, obliquely downward across the abdomen to the front and outer side of the thigh, and then behind the thigh to the start- ing-point. This is to be repeated, at the same time ascending the limb until the hip is covered. A few turns around the abdomen, just above the iliac crests, will complete this dressing. It will be observed that this figure-of-8 turn around the thigh and pelvis, if used alone, will constitute the 16 A CHAPTER IN MINOR SURGERY. Fra. 7.—Bandage for the lower extremity, applicable under all circumstances—especially useful in plaster-of-Paris dressings in fracture of leg and thigh. A CHAPTER IN MINOR SURGERY. 17 gpica bandage used in retaining dressings to the ingui- nal and femoral regions. To Bandage the Head. For retaining ice caps, or other dressings to the head, the hood bandage will be found most convenient, while its modifications will suffice to keep a dressing upon any limited portion of the scalp. (Fig. 8.) To apply this, take a roller twelve yards long, and two and a half inches in width, rolled from both ends to the centre. Holding one head Fra, 8.—The hood bandage, for retaiiing dressings to all portions of the scalp. of the roller in each hand, the surgeon standing behind the patient, and laying the middle of the ban- dage across the forehead just over the eyebrows, carries one head in the right and the other in the left hand around the head, above the ears, and crosses them under the occiput, so that the roller which went to the rear in the left hand will travel again to the front over the 18 A CHAPTER IN MINOR SURGERY. same path. The roller in the right hand is then carried over the head, in the median line, from the occiput to the nose, and at this point it is caught and held down by the encircling turn carried in the left hand. Then carry the