Bandage

 The Oblique Bandage

The oblique bandage is generally used for arms and legs, to retain dressings. 


 Bandaging the Hand

The hand is bandaged by crossing the bandage over the back of the hand Use, to retain dressings. 


 The Cravat

The cravat is folded as usual with cravats. Use, as a bandage for the head, arms, legs, feet, neck, &c. 


 The Cord

The cord is used to compress vessels, when a knot is made in it, and placed over the vessel to be compressed. It is merely a handkerchief twisted in its diagonal. 


 The Long Square

The long square is made by folding the handkerchief in three. Use, as a bandage to the ribs, belly, &c. If one handkerchief is not long enough, sew two together. 


 For the Leg and Foot

For the leg and foot, commence and proceed as directed in the preceding paragraph; then continue if up the leg as ordered in the Recurrent Bandage


 A Bandage for the Belly

A bandage for the belly is placed on the patient as directed for the chest, carrying it spirally from above downwards. Use, to compress belly after dropsy, or retain dressings. 


 Handkerchiefs

Any ordinary handkerchief will do; but a square of linen folded into various shapes answers better. The shapes generally required are as follows:—The triangle, the long square, the cravat, and the cord. 


 The Spiral Bandage

The spiral bandage is generally applied to the trunk and extremities, but is apt to fall off even when very carefully applied; therefore the recurrent bandage, which folds back again, is generally used. 


  A Bandage for the Chest

A bandage for the chest is always placed upon the patient in a sitting posture; and it may be put on in circles, or spirally. Use, in fractures of the ribs, to retain dressings, and after severe contusions. 


 The Triangular Handkerchief

The triangular handkerchief is made by folding it from corner to corner. Use, as a bandage for the head.

Application .—Place the base round the head, and the short part hanging down behind, then tie the long ends over it. 


  Simple and Compound Bandages

Bandages are simple and compound; the former are simple slips rolled up tightly like a roll of ribbon. There is also another simple kind, which is rolled from both ends—this is called a double-headed bandage. The compound bandages are formed of many pieces. 


 Substitutes

As it sometimes happens that it is necessary to apply a bandage at once, and the materials are not at hand it is desirable to know how to substitute something else that any one may apply with ease . This can be readily done with handkerchiefs. 

They Grow to Flowers, or to Weeds.


 For the Foot

Place the end just above the outer ankle, and make two circular turns, to prevent its slipping: then bring it down from the inside of the foot over the instep towards the outer part; pass it under the sole of the foot, and upwards and inward over the instep towards the inner ankle, then round the ankle and repeat again. Use, to retain dressings to the instep, heel, or ankle. 


 Bandages

Bandages are strips of calico, linen, flannel, muslin, elastic webbing, bunting, or some other substance, of various lengths, and from one to six inches wide, free from hems or darns, soft and unglazed. They are better after they have been washed. Their uses are to retain dressings, apparatus, or parts of the body in their proper positions, support the soft parts, and maintain equal pressure. 


 Bandages for Different Parts of the Body 

Bandages for the head should be two inches wide and five yards long; for the neck, two inches wide, and three yards long; for the arm, two inches wide, and seven yards long; for the leg, two inches and a half wide and seven yards long; for the thigh three inches wide, and eight yards long; and for the body, four or six inches wide and ten or twelve yards long. 


 Different Bandages for the Head

For the head, a bandage may be circular, or spiral, or both; in the latter case, commence by placing one circular turn just over the ears; then bring down from left to right, and round the head again, so as to alternate a spiral with a circular turn. Use, to retain dressings on the head or over the eye; but this form soon gets slack. The circular bandage is the best, crossing it over both eyes. 


 Circular Bandages 

Circular bandages are used for the neck , to retain dressings on any part of it, or for blisters, setons, &c.; for the head , to keep dressings on the forehead or any part contained within a circle passing round the head; for the arm , previous to bleeding; for the leg , above the knee; and for the fingers , &c. 


 Multiple Handkerchiefs

Two or more handkerchiefs must sometimes be applied, as in a broken collar-bone, or when it is necessary to keep dressings under the arm. The bandage is applied by knotting the opposite comers of one handkerchief together, and passing the left arm through it, then passing another handkerchief under the right arm, and tying it. By this means we can brace the shoulders well back, and the handkerchief will press firmly over the broken collar-bone: besides, this form of bandage does not readily slip or get slack, but it requires to be combined with the sling, in order to keep the arm steady. 


 To Confine the Ends of Bandages

To confine the ends of bandages some persons use pins, others slit the end for a short distance, and tie the two strips into a knot, and some use a strip of adhesive plaster. Always place the point of a pin in such a position that it cannot prick the patient, or the person dressing the limb, or be liable to be drawn out by using the limb; therefore, as a general rule, turn the head of the pin from the free end of the bandage, of towards the upper part of the limb. The best mode is to sew  the bandage on. A few stitches will hold it more securely than pins can. 

Little Deeds are Like Little Seeds.


 To Apply a Single-Headed Bandage

To apply a single-headed bandage, lay the outside of the end  near to the part to be bandaged, and hold the roll between the little, ring and middle fingers, and the palm of the left hand, using the thumb and forefinger of the same hand to guide it, and the right hand to keep it firm, and pass the bandage partly round the leg towards the left hand. It is sometimes necessary to reverse this order, and therefore it is well to be able to use both hands.

Particular parts require a different method of applying bandages, and therefore it is necessary to describe the most useful separately; and there are different ways of putting on the same bandage, which consist in the manner the folds or turns are made. For example, the circular  bandage is formed by horizontal turns, each of which overlaps the one made before it; the spiral  consists of spiral turns; the oblique  follows a course oblique or slanting to the centre of the limb; and the recurrent  folds back again to the part whence it started. 


 The Recurrent Bandage

The recurrent bandage is the best kind of bandage that we can employ for general purposes. The method of putting it on the leg is as follows: —Apply the end of the bandage that is free, with the outside of it next the skin, and hold this end with the finger and thumb of the left hand, while some one supports the heel of the patient; then with the right hand pass the bandage over the piece you are holding, and keep it crossed thus, until you can place your right forefinger upon the spot where it crosses the other bandage, where it must be kept firm. Now hold the roll of the bandage in your left hand, with the palm turned upwards, and taking care to keep that part of the bandage between your right forefinger, and the roll in your left hand, quite slack ; turn your left hand over, and bring the bandage down upon the leg; then pass the roll under the leg towards your right hand, and repeat this until the leg is bandaged up to the knee, taking care not to drag  the bandage at any time during the process of bandaging. When you arrive at the knee, pass the bandage round the leg in circles just below the knee, and pin it as usual.

Bandaging is very easy, and if you once see any one apply a bandage properly, and attend to these rules, there will not be any difficulty; but bear one thing in mind, without which you will never put on a bandage even decently; and that is, never to drag  or pull at a bandage, but make the turns while it is slack, and you have your right forefinger placed upon the point where it is to be folded down. When a limb is properly bandaged, the folds should run in a line corresponding to the shin-bone. Use, to retain dressings, and for varicose veins. 


Bandaging

Bandaging of Leg. The final stage after the dressing has been put on, consists in the application of the bandage. A bandage possesses advantages over strapping in being less irritating to the skin; in being more quickly put on and taken off; in being more easily removed without disturbing the surface, and in more completely allowing the formation of the granulations.

The bandage is also superior to a laced stocking, as the latter does not properly embrace the foot.

The bandage material can be either gauze, muslin or flannel. The last is considered the best because this material is thin, yielding and elastic and yet almost any degree of compression can be exercised with it.

In edematous swelling in general, the flannel appears very suitable, as it is soft to the skin and accommodates itself to the greater or less distension of the limb, arising from the increase or diminution of the fluid. The bandage should be at least six yards long, if required for an ordinary adult, and the width should be from two to three inches. Every portion of the limb, from the toes to the knees, should be equally and evenly compressed. Compression is of such absolute importance that without it everything else will be comparatively ineffectual. This being so, very much will depend on the manner in which the bandage is employed.

Without practice, it is not easy to properly apply a bandage to the leg, and probably this difficulty is the chief reason why preference is often given to adhesive plaster, as this sticks wherever it is put.

The blistering and excoriation often produced by strapping, and the time consumed in its application, are sufficient reasons for acquiring skill in the art of bandaging; an art whose comforts and advantages are appreciated by the patient.

Before using, the bandage should be rolled up very tightly, so that it may be grasped easily and held in the hand firmly without slipping. In putting it on, unwind only that portion which is being applied to the limb, because if it be loose in the hand, or if a considerable piece be unrolled at a time, it cannot be applied firmly or smoothly. The bandage should always be carried up to the knee, even if the ulcer or wound be seated on the lower part of the leg or on the foot itself, as the object of its application is not merely to cover the ulcer but also to support the vessels of the limb. If the bandage be discontinued on any part of the leg, it is liable to become loose and fall down.

It is desirable also that the patient should not wear a garter above the bandage, as anything unequally tight in the course of the veins is calculated to obstruct the free passage of the blood.

The firmness with which the bandage is put on is, of course, chiefly for the purpose of gaining the good effects of compression on the structures beneath, but besides, it contributes very much in making the bandage remain in its position when applied. Encircle the limb with it in a loose, careless manner, and it will fall down almost immediately the patient begins to walk about. Tight bandaging is extremely well borne if performed in a complete and methodical way, beginning at the lowest portion of the foot around the first joints of the toes and ending just below the knee.

The proper application of the bandage is of such great importance, especially in the treatment of varicose ulcers of the leg, that it should, when possible, always be done by the doctor himself. It is difficult for the most skilled layman to put a bandage on his own leg. The real practical difficulty lies with those patients who live at a distance from the doctor and who can only visit him once a week or at ten day intervals. These must be taught to dress and bandage the limb, and generally some friend or relative will learn to superintend the details.

The length of time which elapses before the bandage and dressings are removed and reapplied must necessarily be determined by the circumstances of each case. When the ulcer is very extensive and the discharge proportionately great, it may be advisable to dress the leg every day at the beginning of the treatment. Generally speaking, an ulcer of the leg is disturbed too often. To take off a dressing and put on another, even though done with the greatest care, interrupts the healing process and the natural steps to cure. Let the dressing remain on until some uneasiness points to the propriety of taking it off, for the purpose of allowing the escape of the discharge. Delay the removal of the dressings as long as possible without carrying the forbearance too far. Avoid extremes of waiting too long or of meddling too soon. Taking the average case, an interval of three days may in general be safely permitted.

Spiral Bandage of the Great Toe. In applying this bandage, the initial extremity of the roller is secured by two or three turns around the ankle and the bandage is carried obliquely across the dorsum of the foot to the base of the toe to be covered, and next to its tip, by oblique turns; a circular turn is then made and the toe is covered by ascending spiral or spiral reverse turns until its base is reached, from which point the bandage is carried obliquely across the dorsum of the foot and finished by one or two circular turns around the ankle. The end of the bandage may be secured by a pin or may be split into two tails and secured by tying.

Spica Bandage of Great Toe. This bandage is applied by placing the initial extremity of the roller upon the ankle and fixing it by two circular turns; the roller is then carried obliquely over the dorsal surface of the foot to the distal extremity of the great toe; a circular turn is next made and the bandage is carried upward over the back of the great toe to the ankle, around which a circular turn should be made; ascending figure of eight turns are then made around the great toe and the ankle, each turn overlapping the previous one, two-thirds, and each figure of eight turn alternating with a circular turn around the ankle. These turns are repeated until the great toe is completely covered with spica turns and the bandage is completed by circular turns around the ankle.

French Bandage of the Foot. In applying this bandage the initial extremity of the roller should be fixed on the leg just above the ankle and secured by two circular turns around the leg; the bandage should be carried obliquely across the dorsum of the foot, to the metatarsophalangeal articulation, at which point a circular turn should be made around the foot; the roller should then be carried up to the foot, covering it with two or three spiral reverse turns; after this a figure of eight turn should be made around the ankle and instep; this should be repeated once to cover the foot, with the exception of the heel, and the bandage continued up the leg with spiral reverse turns.

Spica Bandage of the Foot. In applying this bandage, the initial extremity of the roller should be fixed just above the ankle and secured by two circular turns; the bandage should then be carried obliquely over the dorsum of the foot to the metatarsophalangeal articulation; a circular turn around the foot should be made at this point and the bandage continued upward over the metatarsus by making two or three spiral reverse turns; it should then be carried parallel with the inner or the outer margin of the sole of the foot, according as it is applied to the right or left foot, directly across the posterior surface of the heel, and from this point it should be conducted around the outer border of the toe and over the dorsum, crossing the original turn in the median line of the foot, thus completing the first spica turn. These spica turns should be repeated, gradually ascending, by allowing each turn to cover three-fourths of the preceding one, until the foot is covered, with the exception of the posterior portion of the sole of the heel; the turns should cross one another in the medium line of the foot and should be kept parallel throughout their course.

Bandages for the Foot and Leg. Whenever possible the patient should be kept in bed, or, at least, in the recumbent position with the leg elevated, but when circumstances do not permit of this the veins can be supported in various ways. Elastic stockings are excellent but expensive, and not durable. Bandages of rubber cloth, or woven bandages rendered elastic by the character of the mesh, or Martin's plain rubber bandage may be employed. The last named is put on smoothly but not too tightly, for in walking the leg swells, so that a uniform pressure is established. As the rubber prevents evaporation it acts like a wet compress, stimulating the granulations, but very often producing eczema around the ulcer. The rubber bandage should be washed carefully at night with soap and cold water and must be kept clean. In one patient a firm elastic stocking of vulcanized rubber will give the greatest ease and comfort, while in another the resulting irritation will prove unbearable. As regards the flannel bandage it has already been described at some length.

The essential feature of ambulatory treatment is a good dressing to prevent congestion, and Unna's paste is ideal for this purpose. The paste necessary for the bandage is prepared as follows: first dissolve four parts of the best gelatin in ten parts of water by means of a hot water bath. While the fluid is hot add ten parts of glycerine and four parts of powdered white oxide of zinc; stir briskly until the mixture is cold. Another formula for the paste, and the one recommended, consists of the following: white gelatin, 2-1/2 ounces; water, 8 ounces; zinc oxide, 2-1/2 ounces, and glycerine, 4 ounces; prepared as above. The paste should always be melted before use by placing the receptacle in a hot water bath or in an ordinary copper sterilizer, such as that employed for boiling instruments. A small tin can be used, and a piece of paste about four inches square is cut into fine pieces and put in the can. This is placed in the sterilizer, into which is poured water to a depth of about two inches, so that the can is but slightly immersed. No top should be placed on the can. An ordinary stove or gas range can be used for heating purposes. A very important fact to remember is that no water is to be put into the can with the paste.

The leg is next cleansed, and after the paste has been thoroughly melted it is applied from the base of the toes to the knee, as hot as the patient can comfortably tolerate it, by means of an ordinary small paint-brush. Then a layer of gauze bandage (two to three inches in width, according to the limb) is applied, then a layer of paste, and in this manner two or three thicknesses of bandage are used, depending on the case. In thin people, it is necessary to use only one or two layers of bandage, whereas in stout persons several layers may be required. After the last application of the paste, some non-absorbent cotton is spread on the bandage, giving it the so-called “moleskin” plaster finish. Another way of finishing the dressing is to dust some ordinary talcum powder on the last layer of the paste, giving the bandage the appearance of a plaster-of-Paris dressing. If there is an ulcer, a window can be cut out, thus providing for the drainage of the secretions. The length of time this dressing should be left on depends on a number of conditions, especially the amount of secretion, and whether the patient has to remain on his feet very much. Ordinarily, the bandage can remain on for one week, but indications may be such that it need not be removed sooner than the tenth day, and in some instances it can be kept on for three or four weeks. To remove it, an ordinary bandage-scissors is used to cut the dressing, and it peels off without disturbing any of the granulations on the ulcer.