THE LOWER EXTREMITY.
For adults the most useful width for the rollers is 3 inches, and the length the ordinary one of 8 yards.
The Foot is usually bandaged without covering the heel, and the bandage is begun as follows:—
The roller being held in the right hand for the right foot, or in the left hand for the left foot; the unoccupied hand takes the end, and passing it under the sole, brings it up on the back of the foot just behind the toes, where it is made fast by carrying the roller outwards over the back. When one turn is completed, the bandaging is continued by reverses until the metatarsus is covered, then one or two figures of 8 round the foot and ankle carry the bandage to the leg, where it proceeds upwards by spiral turns round the small of the leg, and by reverses up the calf. The reverses lie at equal distance up the leg, on the muscles, not over the bone, that the skin be not pinched between the crease of the bandage and the bone. When the calf is passed, the roller is continued by figures of 8 above and below the knee, until that joint is covered in, then by reverses up the thigh to the groin, where the bandage terminates by a spica round the body (see page [9]). This is the ordinary bandage for the lower limb. There are some varieties for particular parts, these are:—
To cover the Heel.—Holding the roller as for the foot, pass the end behind the heel, bring it out by the outside over the front of the ankle-joint, and complete the turn with the roller. In doing this, the point of the heel must catch the middle of the bandage. If the foot is a long one, the roller should be three inches broad; but a narrower bandage is more easily fitted on a small foot. After the first turn, the bandaging is continued by carrying the roller in figures of 8 round the foot and ankle, passing alternately above and below the first turn until the ankle is covered as in fig. 19.
Fig. 19.—Covering the Heel.
To bandage a Toe.—Take two turns round the foot, with a bandage one inch wide, then go round the toe to be raised, and back again round the foot. This figure of 8 lifts a toe above the rest if taken from the dorsal, and depresses it if taken from the plantar surface.
The Knee is bandaged by beginning with a simple turn round the leg above the calf, then carrying the roller across the patella to the thigh above the knee: and next entwining it in a circular turn round the thigh before descending over the patella to the leg below the knee, where this is repeated until the knee is covered.
To bandage a Stump.—The flaps are first supported by two or more strips of plaster, one inch wide and ten or twelve long, carried from the under surface of the limb over the face of the stump, and a slip of wet lint and oilskin is applied to the wound. The muscles and soft parts are next confined by a bandage. This is first fixed by simple turns below the nearest joint, and brought downwards in figures of 8 round the limb till the end of the stump is reached, which is next covered in by oblique and circular turns carried alternately over the face of the stump and round the limb, as is shown in fig. 2 for bandaging the head. Or, if a double-headed roller be used, in the manner directed for the capelline bandage on page [5].
Extending a Stump.—When the soft parts fall away from the bone they may be drawn down by attaching a weight by cord and pulley, as described for extending the hip-joint (see fig. 80). The stump should be lightly bandaged and the cord fastened to its upper and under surface. The weight is very small at first, and should be increased from time to time as required.
Many-tail, or 18-tail Bandage, or bandage of Scultetus.—A roller is cut into short lengths long enough to encircle the limb and to let the ends overlap 2 or 3 inches; these are applied separately, the lowest first, the next overlapping it, and the next overlapping the second until the requisite number are applied. Sometimes the tails are attached to each other before they are applied. To do this, the tails are laid out on a table, so that the second overlaps one-third of the width of the first strip, and the third strip overlaps the second, and so on. When all the tails are arranged, a strip is laid across their middle and fastened to each tail by a stitch; but this is not a necessary part of the bandage, and it prevents single tails from being removed. This bandage is used in compound fractures and other wounds, as the soiled strips can be replaced without raising the limb to pass the roller under it.
Elastic Socks and Stockings are made to support varicose veins of the legs. They are woven of india-rubber webbing with silk or cotton. The latter are the lowest priced and often even the most comfortable to wear. The stockings should fit carefully everywhere, especially at the small of the leg, where they generally are too slack, while they cut at the upper end below the knee.
CHAPTER II.
STRAPPING.
Strapping is a method of supporting weak or swollen joints and other parts. Sheets of calico, wash-leather, or white buckskin, spread with lead or soap plaster, are prepared for this purpose. A sheet should be rubbed with a dry cloth before using, to remove adherent dust, &c. It is then cut into strips varying in width between ¾ inch and 2 inches, according to the evenness of the surface to be covered: narrow strips fit best over joints and irregular surfaces. When applied to a limb, the strips should be about one-third longer than its circumference. Each strip or strap is first warmed by holding it to a fire, or by applying its unplastered side to a can of boiling water; when hot, the strip is then drawn tightly and evenly over the part. If the surface to be strapped be irregular, it is best to dip each strip of plaster in hot water before applying it, being thus quite supple the strap fits the limb more exactly. When the limb is thickly beset with hairs, it is a good plan to shave the part where the plaster will lie before putting on the straps.
Strapping the Breast.—Strapping is put on the breast in the same way as the bandage (page [8]). The straps should be not more than 2 inches wide, and long enough to pass forward under the axilla and breast from the lower angle of the scapula on the same side as the injured breast, across the chest as far as the spine of the other scapula. The strips are then warmed and laid on alternately over the breast and across the chest, until the former is fairly supported.
Strapping has this advantage over a bandage—its circular strips do not pass round the chest completely and thereby hamper the breathing as the roller does.
To strap the Testicle.
Apparatus.—1. Strips of soap plaster spread on calico, or better, on wash-leather, ½ inch wide and 12 inches long.
2. A can of boiling water.
3. Razor and soap.
Fig. 20.—Strapping the Testis.
First, shave the scrotum; then tighten the skin over the testis with the left thumb and forefinger passed above it; take a strip of plaster 6 inches long and ½ inch wide, and encircle the cord tightly with it; next pass another strap of the same width, 9 or 10 inches long, from the back of this ring, over the testicle to the front, drawing it tight also (see fig. 20). The strapping is continued by laying fresh straps over each other until the whole testis is covered in. Lastly, take a strip 15 or 20 inches long, and, beginning at the ring above, wind it round and round the testicle until all the vertical strips are confined in place by this spiral strip.
The strapping should be re-applied the second or third day, as the testicle by that time will have shrunk within its case.
Fig. 21.—Strapping an Ulcer.
Fig. 22.—Strapping the Ankle.
Strapping Ulcers and Joints.—Cut strips of plaster one-third longer than the circumference of the part to be strapped; if that is irregular, as the ankle or wrist, they must be narrow: commonly the width varies between ¾ inch and 1½ inch. The strips are warmed, the middle passed behind the limb, the ends crossed in front (see fig. 21) and drawn tight, but with sufficient obliquity for the margins of the strip to lie evenly. The strapping is begun as low down the limb as requisite, and continued upwards by laying on more strips, each overlapping about two-thirds of the preceding strap. When the process is finished, the ends should meet along the same line, and all the uppermost ones be on the same side.
The ankle is strapped differently. Strips are prepared about ¾ inch wide; one is carried behind the heel and its ends brought forward till they meet on the dorsum of the foot; a second, encircling the foot at the toes, secures the first; a third is again carried behind the heel above the first, and is fixed by a fourth round the foot. This is continued until the foot and ankle are firmly supported (see fig 22).
Strapping a Joint with Mercurial Ointment.
(Scott’s Bandage.)
Apparatus.—1. Mercurial ointment.
2. Diachylon plaster.
3. Lint.
4. Spirit of camphor.
5. Cotton wool.
6. Freshly scalded starch, or solution of gum.
7. Binder’s millboard.
Spread the ointment on a piece of lint large enough to cover the joint, and to extend four or six inches above and below it; then wash the joint with warm water and soap and dry it carefully; next sponge it well with the spirit of camphor for five minutes. Tear the lint into strips and wrap it round the joint; then strap the part firmly from below upwards over the lint with strips of diachylon plaster, each overlapping the preceding. Lastly, envelope the joint in a thin layer of cotton wool, and roll a bandage soaked in starch over all. If the patient wears no other kind of splint the bandage may be strengthened by laying a piece of millboard well softened in boiling water along each side of the joint before the starch bandage is applied. As the enlargement of the joint shrinks, this application must be renewed, usually every fortnight is often enough.