Surgical Instruments and Dressing-Box

which grasps the caustic, should be composed of platinum, so as to undergo no chemical change; and the instrument is generally arranged so that by screwing one of its parts upon another it may be very much lengthened, for the purpose of touching the os uteri, pharynx, etc. A razor kept in the pocket- case will sometimes be found of use, in shaving a part to be operated on or dressed. 32.—THE DRESSING-BOX Is essential to order and comfort in hospital surgery. It is simply a wooden box with @ handle, like a large knife-tray, in which is kept a supply of bandages, lint, charpie, ligatures, sponges, strips of adhesive plaster of various widths, towels, a pair of large scissors, a well-furnished pin-cushion, and whatever else the surgeon is likely to need as he makes his rounds. It ought to be divided into compartments, and kept always in order and well replenished. Besides the articles already mentioned, it should contain a few gum-cathe- ters and bougies, with some oil or lard for anointing them; some cerate and a spatula; a bottle or cup of common whiskey for washing, and another of spirit of turpentine. Another instrument which will sometimes be of use is a large double probe, commonly called a gunshot-probe. 16 MATERIALS, ETC. EMPLOYED IN DRESSINGS. The nurse or some other attendant carries the dress- ing-box round after the surgeon as he makes his visit. 28.—THE MATERIALS, ETC. EMPLOYED IN DRESSINGS. Although in an emergency we may make use of almost any material for surgical dressings, yet there are certain articles especially adapted for the purpose, which call for a brief enumeration. Properly speaking, this list should include splints, styptics, etc.; but these may be more conveniently described elsewhere. Lint is more useful than anything else would be, for certain purposes. It may be readily made by drawing out all the cross threads from a piece of old linen, leay- ing only enough to hold the other threads together; its fineness will be in proportion to that of the stuff. A very fine form of it, suitable for small wounds, is made by scraping one side of an old piece of linen with a blunt table-knife, ‘‘ Patent lint,” made by a machine, is sold in the shops; it comes in various grades of fine- ness, either in long pieces or in pound bundles. One of its surfaces is smooth, the other is covered with a cotton-like down. Its expensiveness is the only objec- tion to it. Lint may be employed either in making compresses, as a means of applying ointments or lotions to a part, or as a dry dressing. Generally speaking, its smooth side should be next the affected surface. Nothing can be simpler than the making of a compress, the only points to be regarded being its adaptation to the shape of the part, and the regulation of its thickness. By suitable folding, a piece of lint or old linen may be MATERIALS, ETC. EMPLOYED IN DRESSINGS. 17 fitted or graduated so as to press evenly upon a quite irregular surface. The perforated compress is made by folding the stuff so that it acquires a considerable thickness, and then cutting out a portion so as to fit any part which needs protection from pressure; it is in this way that the India-rubber air-pads sold in the shops are useful in preventing bed-sores, since when inflated they form a circular compress upon which the body rests, while the sacrum is raised and free in the open space at the centre. The cribriform compress is provided with apertures in greater or less number, through which discharges may escape to be absorbed by charpie or some other material, arranged upon its outer surface. The Maltese cross is made by folding a square piece of stuff into a triangle, folding this again in the same man- ner, and then cutting away the two folded edges to near their point of junction; on opening out the piece, it will be found to have assumed the well-known form indi- cated by the above name. A little practice will enable one to judge quite accurately how large the square should be, and how much should be cut away at the angles. This form of compress is much used for stumps, as well as in affections of the female breast. CuHarPIE is composed of the separated threads of linen fabrics; its coarseness or fineness will obviously depend on that of the original stuff. The threads are generally tangled up, so as to form a porous mass. Cot- ton threads are sometimes used, but are more heating to the part than those of flax. Charpie is mainly used as a means of absorbing dis- charges; with this view it may be very advantageously employed in the dressing of stumps, abscesses, or sup- 18 MATERIALS, ETC. EMPLOYED IN DRESSINGS. purating wounds. It should never be placed in imme- diate contact with the affected surface, unless previously soaked or anointed. Authors describe various forms in which charpie may be employed,—the plumasseau or pledget, the roll, the tent, the mesh, the pellet, the tam- pon, etc. But these differ only in their shape, not in the object of their employment, and may be easily de- vised to suit the occasion; it is therefore unnecessary to enter into detail here with respect to them. Raw Corton, as sold in rolls in the shops, is often used for the padding of splints, or to protect parts espe- cially exposed to pressure. It is also extensively used as an application to burns, when the cuticle is not re- moved; and in such cases acts admirably. It is em- ployed as a very gentle irritant to the skin, in cases of rheumatism, and to envelop a part of which the tem- perature is lowered, as by the tying of a large artery; being retained in place by means of a loosely-applied roller, Bray, although its use has been hitherto mainly con- fined to the treatment of compound fractures, may be very suitably employed in many cases of injury of the soft tissues. It is simply heaped over the affected part, and acts by excluding the air, absorbing discharges, and preventing flies from depositing their eggs in the wound, so as to breed maggots. Nothing can serve the purpose better, in the heat of summer, than this light, cool, and cleanly dressing; while the soiled portions can be removed with the greatest ease, without the slightest disturbance of the limb. ™ MATERIALS, ETC. EMPLOYED IN DRESSINGS. 19 Tow sometimes answers very well to protect the patient’s bed, by absorbing discharges; but it is too coarse and irritating to be applied directly to the sur- face of the body. Spones-TEnT, an article at present almost out of date, is made by soaking pieces of sponge in melted beeswax; it is cut and moulded to the required size and shape, and then introduced wherever the union of opposed surfaces is undesirable, or where distension of @ passage is to be effected or kept up. It is very irri- tating, and not very cleanly. AvuEsive PiastEr, the Emplastrum Resine of the U.S. Pharmacopeeia, is an article familiar to every one. It is merely lead plaster, with the addition of some resin, one part to six, spread upon one surface of thin muslin. It may be used for keeping the lips of a wound in contact; for making compression, as in inflammation of the testicle or in ulceration of the leg, according to rules elsewhere given; for making extension and coun- ter-extension in certain fractures, as will be mentioned when we come to speak of that class of injuries; and in & great many other cases. Adhesive plaster is very irritating, and should never be applied as a mere covering to wounds or sores; its traction should be exerted only upon the sound skin. Hence it is always cut into strips for use; and the width of the piece as sold is such that the strips may for almost every purpose be cut crosswise. The end of the piece should be towards the surgeon’s left, and the edge opposite him held by an assistant; then he makes the other edge tense, by taking hold of its extremity with 20 MATERIALS, ETC. EMPLOYED IN DRESSINGS. the finger and thumb of his left hand, the thumb upper- most, and stretching it by means of the middle and ring fingers of the same hand; now passing one blade of a pair of scissors underneath the edge, he carries them straight across by a quick pushing motion. Each suc- cessive strip is cut from the extremity of the piece in the same way; but when the length required is such that this would involve much waste in the subsequent application, the strips may be cut along the piece in- stead of across it. Fig. 16, The strips thus cut must be warmed for use, unless the temperature of the air is so high as to render them sufficiently adhesive. A very good plan is to have a can of hot water, to the outside of which the back of * MATERIALS, ETO. EMPLOYED IN DRESSINGS. 21 each strip is applied before it is pat on; some surgeons prefer the flame of a spirit-lamp. Friction of the strip by drawing it several times between the thumb and finger, in the absence of other sources of heat, may answer the same purpose, and is more convenient when but a few strips are to be employed. In order to remove adhesive plaster, all that is neces- sary is to sponge it either with hot water, which softens the adhesive material, or with oil of turpentine, which dissolves it. Perhaps I need hardly remark that hairy parts should be shaved before the plaster is applied, not only because it will hold better, but because its subse- quent removal is much easier if this is done. Some other points will be alluded to in connection with the dressing of wounds. In order to prevent the adhesive strips from stretch- ing after they are applied, they are either stretched as much as possible by the surgeon before they are put on, or, which is better, they are cut inthe direction of the length instead of the breadth of the piece. Istnauass Puasrer is sold at present at all the apothecary shops, and has a very extensive popularity. It is made by washing over one side of a piece of thin silk with a spirituous solution of isinglass; and is gen- erally used just as adhesive plaster is, except that it is moistened with a wet sponge instead of being heated, in order to its application. Being quite mild and un- irritating, it may be employed as an artificial scab for small ulcers. For use on the field, in military surgery, isinglass plaster has some very great advantages over the ordi- nary resin plaster. Its bulk is less, and in warm cli- 8 . 22 MATERIALS, ETC. EMPLOYED IN DRESSINGS. mates and seasons it may be carried without undergoing any change. The water required to prepare it for in- stant application can always be had, and dressings may be performed very rapidly with it. Hence it has ob tained great favor with our army surgeons during the present war. When neither of these forms of adhesive plaster can be obtained, a good substitute may be made by mixing flour with white of eggs, so as to form a paste. Strips of thin linen or muslin imbued with this and laid on the skin, will in drying take s very firm hold. Wetting with warm water will loosen them again. Cottopion, made by dissolving gun-cotton in sul- phuric ether, is much used as an adhesive material. After operations on the eye, it is employed to keep the lids closed. For this purpose, or for keeping the lips of a wound in apposition, a piece of fine soft rag is laid with its centre directly over the affected part, and then the collodion is painted on with a camel’s-hair pencil, so as to attach each end of the rag to the sound skin be- neath it. Thus the wound or the eye is left free from irritation, or may have any other suitable dressing con- fined upon it. Small wounds may be simply painted over with the collodion, which is also applied in some cases for the sake of the contraction undergone by it in drying; small nevi may sometimes be entirely discussed in this way, and occasionally even vascular engorge- ments of the testicle, breast and other organs. Mr. Hubbell, the well-known druggist of this city, prepares @ non-contractile form of collodion, by adding to every 3j 388 of liquid Venice turpentine or of castor oil. The former makes a better preparation, unless it MATERIALS, ETC. EMPLOYED IN DRESSINGS. 23 is specially desirable to avoid irritating the parts. Either will be found to possess advantages over collodion as commonly prepared. An excellent substitute for blisters of the ordinary form is obtained by dissolving an ethereal extract of cantharides in collodion. It is called blistering or can- tharidal eollodion; the mode of employing it being simply to paint it over the desired extent of surface by means of a camel’s-hair pencil. Its action is hastened by laying over it a piece of oiled silk, so as to prevent the evaporation of the ether. Some surgeons also use collodion as a vehicle for the application of creosote, in cases of erysipelas or erythema of the traumatic variety. Whenever it is desirable to remove collodion, either simple or medicated, this may readily be done by dis- solving it away with ether. Warer-cuass is the name given to an article lately proposed by Kiichenmeister as a partial substitute for collodion. It is made by melting together 10 parts of potassa, 15 of powdered quartz, and 1 of charcoal, forming a blackish-gray mass; this is dissolved in 5 parts of water, and the solution evaporated to a semi- fluid consistence. The substance thus formed has an alkaline reaction, and dries slowly, forming an im- permeable coating to wounds, swellings, and skin dis- eases; on account of its alkaline reaction, it is particu- larly recommended for the stings of insects, snake-bites, ete. As yet, however, it has been tried only to a very limited extent. Pouttices or CaTapLasMs, if well made, are ex- tremely useful; they are intended to act mainly by