第2章

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.

11.Thefollowingaretheobjectwhichtheupperbandage,theunderbandage,orbothaimat:Theobjectoftheunderbandageiseithertobringtogetherpartsthatareseparated,ortocompresssuchasareexpanded,ortoseparatewhatarecontracted,ortorestoretoshapewhataredistorted,orthecontrary.Itisnecessarytopreparepiecesoflinencloth,whicharelight,thin,soft,clean,havingnoseamsnorprotuberancesonthem,butsound,andabletobearsomestretching,orevenalittlemorethanrequired;notdry,butwettedwithajuicesuitabletothepurposerequired.Wemustdealwithpartsseparated(inasinus?)insuchwise,thatthepartswhichareraisedmaytouchthebottomwithoutproducingpressure;wemustbeginonthesoundpart,andterminateatthewound;sothatwhateverhumorisinitmaybeexpelled,andthatitmaybepreventedfromcollectingmore.Andstraightpartsaretobebandagedinastraightdirection,andobliqueobliquely,insuchapositionastocreatenopain;andsothattheremaybenoconstrictionnorfallingoffonachangeofposition,eitherforthepurposeoftakingholdofanything,orlayingthelimb;andthatmuscles,veins,nerves,andbonesmaybeproperlyplacedandadjustedtooneanother.Itshouldberaisedorlaidinanaturalposition,soasnottooccasionpain.Inthosecasesinwhichanabscessisformed,wemustactinacontraryway.Whenourobjectistobringtogetherpartswhichhavebecomeexpanded,inotherrespectswemustproceedonthesameplain;andwemustcommencethebringingtogetherfromsomeconsiderabledistance;andaftertheirapproach,wemustapplycompression,atfirstslight,andafterwardsstronger,thelimitofitbeingtheactualcontactoftheparts.Inordertoseparatepartswhicharedrawntogether,whenattendedwithinflammation,wemustproceedontheoppositeplan;butwhenwithoutinflammation,wemustusethesamepreparations,butbandageintheoppositedirection.Inordertorectifydistortedparts,wemustproceedotherwiseonthesameprinciples;butthepartswhichareseparatedmustbebroughttogetherbyanunderbandage,byagglutinants,andbysuspendingit(thelimb?)initsnaturalposition.Andwhenthedeformitiesarethecontrary,thisistobedoneonthecontraryplan.