(From de and ligo, to tie). A bandage.
The design of bandages is chiefly to secure the dressings, or to confine the motion of parts which might be painful or injurious. In ulcers, they support the dressings, defend the newly formed skin from any force which might separate it, and bring the edges both of these and of wounds nearer; so that there will be less for nature to supply. That they support and preserve the ends of fractured limbs in a proper position, is too obvious to be particularly pointed out. In some instances they are necessary to keep parts asunder; and are very frequently useful in preventing a too luxuriant growth of new parts, accumulations of purulent matter in sinuses, of watery fluids in the extremities, as well as in confining prolapsed organs.
Bandages are made of linen, cotton, or flannel. They should be, if possible, without a seam, and linen is wove for this purpose; but the selvage is always harsh, and as the edges are necessarily covered by the next round, they are sometimes inconvenient. We prefer, therefore, old linen; and more readily submit to the inconveniences of the edges unravelling, than to the irregularity which any stitching would produce. The length often renders seams necessary. The pieces must, therefore, be united by back stitching, and beat smooth.
Linen is generally preferred for bandages; and it should be such as has been long worn, as its harshness is thus diminished or destroyed. We have lately employed cotton (calico), and have perceived many advantages from its softness and elasticity. Where some motion of the part is necessary, flannel is preferable, from its greater elasticity; and it is used in ulcers of the legs, wounds of the thorax, and in the operation of the paracentesis: all its advantages are, however, to be found in calico.
The application of bandages can scarcely be taught by words; actual observation, and, indeed, experience, are required. The young surgeon should therefore be exercised in applying them to a proper figure, for it is a
3z part of his profession which every nurse can judge of. Should he perform it without effect or dexterity, he will have little credit for talents in any other branch. It is, however, often of importance, that the pressure should bear equally on every part; that in other cases it should gradually increase or lessen; and occasionally the force of the bandage is limited, while the parts above and below are useful only as they support the principal. With all these views, the surgeon should accustom himself to apply them; and he will find considerable assistance in the works of the French surgeons, who roll over an affected part many yards of bandage with the utmost dexterity and neatness. See Heister's Surgery, vol. ii. tables 37 and 38.
Bandages are either simple or compound; but they are sometimes divided into general and particular: and the latter are often denominated from the part to which they are applied.
A simple bandage is a long piece of linen or cotton of an indefinite length, and from three to six inches in breadth. When applied, it is usually rolled up; and the rolled part is styled its head. When rolled from each end, it is styled a double-headed bandage. The part applied to the limb should be the opposite to that on which it is rolled, so that it may unroll from above, and not embarrass the operator. In the circular turns, it should be unrolled towards the surgeon, and great care should be taken that the edges are kept smooth. This will seldom be effected, unless at least one third, often one half, of the bandage is covered by the succeeding turn. The first turns should be wholly circular, for security.
The bandage is frequently returned to secure the edges, and prevent its slipping. This is effected by folding it, at a right angle, when it can be easily rolled the opposite way without any gaping edge. The chief of the simple bandages are, the circular, the spiral, the uniting, the retaining, the excellent, and the creeping bandages.
The circular bandage is the simplest form; the rolls cover each other, and it is seldom long, as two or three rolls are sufficient. The spiral bandage is that already described; and modern practice has extended its utility, by applying it in many obstinate diseases, where it is the only remedy. In the upper extremity, the fingers are first swathed with smaller fillets, and these secured on the back of the hand by the larger bandage; it is then carried up the arm to the elbow, where the bandage is crossed in the form of a figure of 8, as after bleeding, and from thence up the humerus, where it must be returned. The toes need not be swathed; but the heel must be confined by a piece of linen drawn tight, and secured with the roller, and the cavities on each side of the tendo-achillis filled with lint. The bandage is then carried to the calf of the leg, to the knee and thigh reversed, where the increasing bulk prevents it from lying smooth. In these cases the bandage must not be too tight, especially if it is to be wetted; for it is contracted by moisture. If the proper degree of tightness cannot be ascertained, it may be applied wet.
The uniting bandage, or spica descendens, used in rectilinear wounds, made with a double-headed roller, with a longitudinal slit in the middle, of three or four inches long. After dressing the wound, compresses should be applied on each side of it, so as to press front the bottom to the lips of the wound, before the roller is applied; which roller having one head passed through the slit, an opportunity will be given of drawing the lips of the wound together. The whole must be managed so that the bandage may act equally. Where wounds are stitched, this bandage supports the stitches, and prevents their tearing. When the wound is deep, a long compress is to be applied on each side, to secure a pressure at the bottom. When the wound is very long, two or three bandages should be employed, and great care must be taken that the pressure is perfectly equable.
Henkel and Richter recommend for this purpose a compound bandage, consisting of four straps of linen of the usual breadth, and a length suitable to the wound. These are united by six narrow straps crossing each other like the fingers of the hand when folded. When applied, the middle of the bandage, or the narrow straps, cover the wound, and two of the heads on each side of it cover each other. The two lowest are then placed circularly round the limb. The two heads are drawn tight with both hands, and fastened. As the narrow straps lie over the wound, we have thus a constant view of it.
The retentive bandage is usually the single-headed roller. It should be applied first on one side, opposite to the wound, and brought round, so as to bring the lips of the wound closer. The contrary manner separates the lips.
The expellent bandage is designed, by an equable pressure, to keep the fluids within so near to the orifice of the wound that sinuses may be prevented. In general, a compress of unequal thickness is necessary; and the thinner part of the compress is placed next, and immediately contiguous, to the orifice: the thicker below. Before it is fixed, the pus must be completely pressed out, and the rolling begun with two or three circular turns on-the lower part of the compress. The bandage must then be carried spirally, but somewhat slacker, upwards, and again return to its commencement. It becomes an uniting bandage when a piece of flesh is lacerated, and we wish to heal it by the first intention.
The creeping is a simple bandage, where the succeeding turn only covers the edge of the preceding. It is employed where the object is merely to secure the dressings, and not to make any considerable or equable pressure.
The compound bandages are the eighteen-tailed, or rather the many-headed, bandage, and the T bandage. The first consists of three pieces of linen, about a foot in length and in width. These are sewed together in the middle, and each end divided into three equal parts; the division continued to about two inches and a half from the centre. These are arranged so as to press equally on the limb, which it will do, if the head which overlaps is received in a slit of the corresponding piece. This bandage has been varied by Dessault and others, in a manner which we find almost incapable of being conveyed by words.
The T bandage is chiefly used in injuries of the abdomen and back; but particularly of the genital organs, and the neighbouring parts. It is of the shape of the letter. The transverse part passes round the waist, and the other part between the legs. If the latter is divided, it may press on either groin, when brought up to unite with the bandage which surrounds the waist. We shall add a short description of some other bandages, neither simple nor compound, before we proceed to the particular ones.
The triangular bandage is generally a handkerchief doubled into that form. In common cases it is used on the head, also as a support to the testicles when swelled, called by the French couvre-chef en triangle.
The nodose bandage, called scapha. It is a double-headed roller, made of a fillet four yards long, and about an inch and a half broad; it must be reversed two or three times, so as to form a knot upon the part which is to be compressed. It is employed when an haemorrhage from a wound is to be stopped, or for securing the compress after bleeding any part of the head.
The quadrangular bandage is about three feet square, or a little longer than broad. The French call it le grand couvre-chef.
The reflex bandage. See Capelina. The particular bandages we shall consider under the article Fascia.
For the practice of the ancients in this part of surgery, see Vidus Vidiua. For more modern directions, Heistcr's Surgery; M. M. Sue, and Thilloye; Pott's Works; Bell's Surgery, vol. vi. p. 469; Lombard and Bernstein. The scapularia, scapulary, and napkin, is a piece of cloth four or six fingers broad, with a slit in the middle to pass the head through, and long enough to reach from the bottom of the sternum over the shoulders, and down the back, as low as the sternum is before. For the spica inguinalis, inguinalis duplex, snd simplex, see Spica. The Stella, Monoculus, Discrimen, Ha-bbma, Hemiceraunios, Auriga, Chiastos, Chiaste, may be found under their respective heads. For circu-lus, and plinthius laqueus, see Circus quadruple*. Deliquatio, (from deliqueo, to melt). See Solutio.