ON THE SURGERY

第2章

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第2章

ON THE SURGERY American Medical Association S

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ON THE SURGERY
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  8.Therearetwousefulpurposestobefulfilledbybandaging:

  (first,)strength,whichisimpartedbythecompressionandthenumberoffolds.Inonecasethebandageeffectsthecure,andinanotheritcontributestothecure.Forthesepurposesthisistherule—

  thattheforceoftheconstrictionbesuchastopreventtheadjoiningpartsfromseparating,withoutcompressingthemmuch,andsothatthepartsmaybeadjustedbutnotforcedtogether;andthattheconstrictionbesmallattheextremities,andleastofallinthemiddle.Theknotandthethreadthatispassedthroughshouldnotbeinadownwardbutinanupwarddirection,regardbeinghadtothecircumstancesunderwhichthecaseispresented;toposition,tothebandaging,andtothecompression.Thecommencementoftheligaturesisnottobeplacedatthewound,butwherethekriotissituated.Theknotshouldnotbeplacedwhereitwillbeexposedtofriction,norwhereitwillbeintheway,norwhereitwillbeuseless.Theknotandthethreadshouldbesoft,andnotlarge.

  9.(Second.)Oneoughttobewellawarethateverybandagehasatendencytofallofftowardsthepartthatdeclinesorbecomessmaller;as,forexample,upwards,inthecaseofthehead,anddownwards,inthecaseoftheleg.Theturnsofthebandageshouldbemadefromrighttoleft,andfromlefttoright,exceptonthehead,whereitshouldbeinastraightdirection.Whenoppositepartsaretobebandagedtogether,wemustuseabandagewithtwoheads;orifwemakeuseofabandagewithonehead,wemustattachitinlikemanneratsomefixedpoint:such,forexample,asthemiddleofthehead;andsoinothercases.Thosepartswhicharemuchexposedtomotion,suchasthejoints,wherethereisaflexion,shouldhavefewandslightbandagesappliedtothem,asattheham;butwherethereismuchextension,thebandageshouldbesingleandbroad,asatthekneepan;andforthemaintenanceofthebandageinitsproperplace,someturnsshouldbecarriedtothosepartswhicharenotmuchmoved,andarelank,suchasthepartsaboveandbelowtheknee.Inthecaseoftheshoulder;afoldshouldbecarriedroundbytheotherarmpit;inthatofthegroin,bytheflanksoftheoppositeside;andoftheleg,toabovethecalfoftheleg.Whenthebandagehasatendencytoescapeabove,itshouldbesecuredbelow,andviceversa;andwherethereisnomeansofdoingthis,asinthecaseofthehead,theturnsaretobemademostlyonthemostlevelpartofthehead,andthefoldsaretobedonewithaslittleobliquityaspossible,sothatthefirmestpartbeinglastappliedmaysecuretheportionswhicharemoremovable.Whenwecannotsecurethebandagingbymeansoffoldsofthecloth,norbysuspendingthemfromtheoppositeside,wemusthaverecoursetostitchingitwithligatures,eitherpassedcircularlyorintheformofaseam.

  10.Thebandagesshouldbeclean,light,soft,andthin.Oneshouldpracticerollingwithbothhandstogether,andwitheitherseparately.Oneshouldalsochooseasuitableone,accordingtothebreadthandthicknessoftheparts.Theheadsofthebandagesshouldbehard,smooth,andneatlyputon.Thatsortofbandagingistheworstwhichquicklyfallsoff;butthosearebadbandageswhichneithercompressnoryetcomeoff.

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