BAN 



£ut as the hernia is not always of equal fize, being 

 fmaller in the morning, and larger after meals, and as it 

 alternately rifes and finks in infpiration and expiration, 

 it is evident that thtfe finelaftic bandages cannot adapt 

 themfelvts to thofe diverfitics, as they eitlier render necef- 

 fary a llronu-er, inconvenient, and often hurtlul prefTiire, or 

 do not prefs fiilficit-nt'y, fo that the hernia is coiillantly in 

 danijrr of (lippmg throngh. 



With adults therefore we can expcft no fecuritv, except 

 in the ufc of elaftic bandages for the umbilical hernia ; and 

 of thefe tlure are fimple, compound, and double ba rJa'res. 

 The frrplc bandage confi'.ts of a fomewiiat broad, round, 

 or oval culhion, and an clnlic fcmicirclc. With palicnts 

 whofe umbilical region is more debilitated, an oval cnfliion 

 is p-quifite, having in the middle a bulb of the fize of a 

 walnut, which comes to lie npo" the navel. Mr. Richtcr 

 alfo rccommendrs the ufe of a common bandage for the in- 

 guinal hernia, provided in its front with a (hicld, to the inner 

 lide of which a cufliion is attached. However, this and 

 the above-mentioned rupture bandages are not fi'.fiic'ently fe- 

 cnre againft flipping out ot their Jituation, on account of 

 their being provided only with a fingle lateral fpring. 



Mr. Theden has propofcd the ufe of elallic g'^m forband- 

 ag-s for the umbilical hernia ; and Mr. Juville thinks that it 

 may be fufficient with patients that are not orpulent, and 

 when the hernia is fmall. But as elailic gum lofes its elaf- 

 ticity when it grows warm, it has been propofcd to fuper- 

 fede its ufe by the application of fpiial fleel fprings to both 

 fides of the cufliion. However, both thefe methods are 

 liable to the objedlion, that they produce the fame preffure 

 upon the whole furrounding pait of the abdomen, as they 

 do upon the navel itfclf ; and confequcntly the culhlon either 

 does not comprefs the navel fufficiendy, or ic prefles it more 

 than is neceffary. 



A better bandage than thefe, for the umbilical hernia, is 

 that of Squire, which confifts of a plate, with a cnfhion 

 fcrewed to it, and two lateral fprings proceeding from the 

 plate, which, when it is applied, firmly embrace the body. 

 An elailic bandage of another kindisthat of Snrstfche, which 

 Mr. Richter (Abhandlung von den Bruechen. Gottingeu, 

 J785, p. 641. tab. vii.) has defcribed, delineated, and in a 

 high degree improved. Two bandages of Mr. Juville for 

 umbilical hernia, of which the one is.defcribed and dellticated 

 by Mr. Bell, and the other by Mr. Hofer. (Lehrfacke des 

 Chirnrg. Vcrbandes. Th. II. Erlnngen, 179!, p. 278. tab. 

 xi. fig. 77-) Dr. Alex. Monro, fenior, has alfo defcribed 

 a bandage, confilling ot a ftcel fpring, which, after the 

 hernia has been reduced, is placed upon the navtl, and re- 

 tained in this fituation by a band:ige. It is drawn as tight 

 as may be neceflHry by means of ilraps and buckles. 



When, as fometimes occurs, the hernia has formed adhe- 

 fions, either fpontaneoufly, or in confequence of improper 

 bandaging, in which cafe its reduftion is altogether imprac- 

 ticable, we muft ufc a concave cudiion, inllcad of a convex 

 one, that may receive the hernia into its hollow, and prevent 

 the farther protrufion of the inteftines. If the bandage be 

 fliilfuUy conftrtK^ed, the adhefions may gradually be dimi- 

 nifhed, and the hernia at length reduced. 



The uniltng Bandage. This is a common double-headed 

 bandage, and one of the moft ufeful and indifpenfible 

 which is ufed in cafe of frefti wounds, in order to promote 

 their fpeedy re-union. Properly it is only adapted for fuch 

 wounds as run in the direftion of the body and limb, and 

 that are fituated in parts which admit of the application of a 

 bandage ; however, it may alfo be ufed in cafes of tranfverfe 

 wounds; but then it rather belongs to the compound band- 

 ages. It may be formed in different ways : I'/z. 



;. According to one method of forming it, its length 



B A JI 



mull be regulated by the circumference of the wounded 

 part, and its breadth muft be equal to the length of the 

 wound. In general, however, it is rather ufed nari-ow than 

 broad, and it mufl always be fo long that the wounded limb 

 can be thrice encircled with it. In the m'ddle part it muft 

 have a large flit, through which the head of the bandage 

 rolled up may ealily be palled. In applying it, the furgeou 

 takes one of its he;'ds into each of his hands, applies that 

 portion oi the middle part that is not flit to the fide cf the 

 limb oppofiteto the wound, brir'gs both the heads round the 

 limb tow>xds the wound, paffes one of t'ue heads throngh 

 the flit, over the wound, drawing both heads in fuch a man- 

 ner as to brii>g the lips of the wound together; after 

 which the one head is rcikd round the limb above the wound, 

 a! d the other below it. When tiie wound is deep, a lon- 

 gncttc is applied under the bandage to each of th'^ lips of 

 the wound, at fome diftance from its edges ; the th'cknefs 

 of thefe loi'.guettes mull be proportionate to the depth of 

 the wound, and by means of them the bottom of the 

 Wound is prefTed together when the bandage is drawn tight. 

 When the wound is very long, we muft either apply 

 feveral bandages, one at the fide of the other, or make 

 feveral flits in a fingle bandage, and pafs the head through 

 the fecond flit over the firft turn, and there draw the lips of 

 the wound together, and fo alfo the fecond and the third 

 time. In tl.is cafe it will be beft to make the flitg whilft 

 we are applving the bandages, namely, at the place where 

 the two hcada meet each other, as othcrwife they do not 

 fit accurately to the wound. The application of this band- 

 age, however, requires great accuracy. If it be applied 

 too tight, it excites pain, fwelling, inflammation, and fruftrates 

 the purpofe of re-union ; but if it be applied too loofe, the 

 lips ot the wound do not come into contadl with each other, 

 and the re-union is not properly effected. 



2. Another more convenient bandage which is equally 

 applicable to longitudinal and to tranfverfe wounds, is that 

 w'aich has already been recommended by Mr. Hetikel. ( An- 

 weifung zum vcrbeff. Verbande, Berlin, 1767, 8. p. 237. 

 Tii/i. XV. _y?^. 104. — Alfo Richter's Anfangfgruende des 

 Wnndarzneykunft. B.I. Tab. \. Jig. 2.) It confifts of four 

 llripes of linen, each of which is from one to two feet in 

 length, and two or three inches in breadth. The dimen- 

 fions, however, miiit always be regulated according to thofe 

 of the difeafed pai t. Thefe four pieces are united by means 

 of fix narrow ftraps in fuch a manner, that all the fix tlraps 

 crofs eacli other like the fingers of the hand when folded. 

 In this manner we obtain a four-headed crucial bandage, in 

 which the fix narrow ftraps form the centre of the whole. 



When it is applied, tlie narrow ilraps, or the middle of 

 the bandage, muil be placed direftly over the wound, and 

 two of the heads muft lie on each fide of it, in fuch a m.ar.ner 

 that the one entirely covers the other. Firft, the two loweft 

 heads on each fide are faftened quite loofe round the limb 

 with circular tunis. The two heads above are then alfo hrft 

 drawn tight with both hands, and then faftened in the fame 

 manner as the former. When this bandage is ufed, we 

 have conftantly a view of the wound, as the narrow Ilraps 

 lie immediately over it. 



3. Mr. Boettcher (Aufwahl des chirurgifchen Verbandes, 

 Berlin, 1795. p. 62. ^71.) has alio recommended a veiy 

 fimple bandage for promoting the re-union of longitudinal 

 wounds. He takes a common two-headed bandage, two 

 or three fingers in breadth ; and firft applies to each fide 

 of the wound, at the diftance of from half an inch to three 

 inches from the edge, a longuette, which in the mean time 

 is held by an afiiftant ; he then takes one of the heads into 

 each hand, and makes the beginning with the middle of the 

 bandage, on the fide of the hmb oppofite to the wound. 



The 



