Apparatus.
Two bandages, each 3 yards long and 2 inches wide, of calico or saddle-girth, with tapes sewed on the ends.
Fig. 92.—Tying for lithotomy.
The patient is laid on his back, a slip-knot made in the middle of the bandage and passed over the wrist; the hand is then made to grasp the foot, the thumb above, the fingers under the sole (fig. 92); one end of the bandage is carried behind and inside the ankle to the dorsum of the foot, where it meets the other end passing in front of the ankle. The ends are then carried under the sole, brought up and tied in a double bow over the back of the hand.
Bedsores are best treated by great cleanliness, and by washing the skin exposed to the discharges with spirit of wine every day. Brown-Sequard recommends cold and heat to be applied daily, by means of an ice bag for ten minutes, followed by a warm poultice for an hour. The pressure of the skin over the sacrum or trochanters is prevented by a ring of soft thick felt, covered on one side with adhesive plaster, and applied like a corn plaster around the prominent bone.
In addition to these local applications, the pressure of the body should be evenly distributed over its under surface by placing the patient on a water cushion, or, better, on Arnott’s water-bed.
Fig. 93.—Water-bed.
Arnott’s Floating Bed.—In the hydrostatic or floating bed of Dr. Arnott, the patient floats on the surface of a trough of water, into which he sinks until he has displaced his own weight of water; his floating apparatus, or raft, so to speak, being a sheet of waterproofing, and a thin mattress or folded blanket, on which he lies. The bed consists of a trough running on large castors, about 8 feet long, 2 feet 8 inches wide, and 1 deep, with a tap at the bottom for letting out the water, and a spout in one corner to fill it by. Over the top a macintosh cloth is spread, its edges being firmly nailed to the margin of the trough, but the cloth is left slack enough to float easily on the surface of the water when the trough is partly filled. This slackness is requisite to allow the water displaced by the weight of the patient’s body to rise up around him without tightening the cloth, or the floating principle of the bed is not carried out, and the pressure of the patient’s weight not evenly distributed over his body (see fig. 93). Three or four blankets are laid evenly over the macintosh, and these again protected from the moisture of the patient by a macintosh under-sheet. If a mattress is used, it must be very thin, and supple enough to let the surface of the water adjust itself to the patient’s body and receive the pressure evenly. The water employed to fill the bath should be about 50°.