The essentials of bandaging /

by Berkeley Hill

3. Silk thread.

4. A body roller or folded sheet.

The sponge should be cut into pieces the size of nuts; if the sponge is compressed it answers better. When prepared, the vagina should be cleared of coagula by a syringeful of ice-cold water; the handkerchief, unfolded and thrown over the right hand, is passed up the vagina till its centre reaches the os uteri, the borders and ends then project from the vagina. The interior of the handkerchief is next filled by firmly packing the sponge in bit by bit until the vagina is distended by the mass; the ends of the handkerchief are then tied together. The sponge swells as it absorbs the blood, and compresses the bleeding vessels by its distention.

The abdomen and uterus are then supported by a body roller, or folded sheet, wrapped tightly round the hips and waist, while the patient, lightly clad, is kept quiet in a cool chamber.

When the plug has answered its purpose it is removed, by withdrawing the sponge bit by bit, and the vagina is washed with tepid water.

The kite’s-tail plug.—Masses of cotton wool the size of a hen’s egg are tied at two inches distance from each other along a long string. When about a dozen are tied on, a speculum is introduced, and the first ball of wool is passed to the bleeding point and pushed firmly against it, and then another, and so on, until the vagina is firmly packed. An end of string is left hanging out of the vulva, whereby the plug may be removed when necessary. Each mass comes away successively with ease as the string is pulled out of the vagina.

Injecting the Urethra often fails from the inefficient mode in which it is done. The syringe employed should be short enough to be worked easily with one hand, and need not contain more than one or two tea-spoonfuls, as the capacity of the urethra does not exceed that amount. One of such a size is just 2 inches in length, and easily worked by one hand. The opening through the nozzle should also be wide, that a forcible stream may be injected into the urethra.

The patient should fill the syringe, then place on a chair or stool before him a chamber pot, and, having just made water to clear out the discharge collected in the urethra, he inserts the slightly bulbous nozzle into the meatus urinarius. He then grasps the sides of the glans with the left forefinger and thumb to close the mouth of the passage. The right forefinger next presses down the piston slowly, so that the whole of the injection passes into the canal and distends it; keeping the meatus shut with his left finger and thumb, the patient lays down the syringe and rubs the under part of the penis backwards and forwards, that the injection may be forced into any folds or follicles of the mucous membrane. Having thus occupied about thirty seconds, he releases the mouth of the passage, when the fluid is ejected sharply into the vessel placed ready to receive it. This rapid ejection is a test of the proper performance of the operation.

In counselling the use of astringent solutions, the surgeon should always caution the patient not to employ one that produces severe smarting, which lasts more than a few minutes after injection. If it causes much pain, the solution is too strong.

Catheters and Bougies.—Silver catheters are made in sizes, increasing from No. ¼ to No. 12, the first having a diameter of 0·64 inch, the latter 0·25 inch. Larger ones than these are seldom employed.