Dublin Journal of Medical Science
On the starched ;Bandage in Fractures.--M. Seutin, the eminent surgeon of Brussels, accompanied by Doctor Simonart, has just paid this city a visit. As is well known, he is the inventor of the use of the starch bandage in fractures. He availed himself of an opportunity afforded him by Mr. Cusack in Steevens' Hospital to put his apparatus on the leg of a little boy who had fractured both bones a fortnight before. Sir Philip Crampton, Mr. Cusack, and a number of surgeons and pupils were present ;
... pils were present ; M. Seutin stated how anxious he was himself to exhibit the application of the apparatus, because he had found that one great reason of its not having been more extensively used, nay, in some instances not even tried, was owing to its having been generally misunderstood. One great objection had been, that the apparatus, when once put on, remained a hard case round the limb, allowing no room for tim necessary degree of tu. mefaction, and consequently endangering the safety of the member by inducing gangrene; that as the parts were hid from view, no timely warning was afforded of such accidents. As the starch bandage was used, there was much truth in this objection; as M. Seutin now uses it, the occurrence of such dangers is obviated. He first applied a calico roller, moderately firm, round the leg ; no starch was put on the inside of this bandage, as it would stick in the hairs, and prove unpleasant to the skin when it hardened. After it was applied, some starch was smeared along its surface ; wherever pressure was wished to be avoided, pledgers of soft lint were put; a soft pasteboard splint, a little starched on the inside, was then placed on each side of the leg, and then one behind, the part about the heel and the hollow of the tendo achillis being well stuffed with lint ; a pasteboard splint was also then put in front. These were secured by a bandage smeared with starch, the end of the bandage being turned down and stuck in front, so as to be easily found. More starched bandage was applied, till the whole was a firm and smooth case. This should be left for twentyfour hours ; when it has become quite dry, it is then slit down along the whole front of the outside in the space between the tibia and fibula, down to the end of the foot ; when the sides of this opening are held aside, the state of the limb can be examined. If it is found to press too much on any part, a little lint can be inserted, so as to raise the apparatus from the place pressed on : should it be desirable, any part of it covering a wound, &c. can be cut away, to allow the Scientific Intelligence.. proper dressings to be applied, and the discharge to get out. Modified as it now is, we cannot but think, that M. Seutin will have the gratification of seeing his method generally used. We insert the accounts given by his pupils, MM. $imonart and Porcelet, of the circumstances to be observed in the application of the starch bandage. " In the construction of the starch bandage,* use is made of the bandages of Scultetus, long or short, made of half-used linen, neither too coarse nor too fine, replaced if necessary in the central layers, by rather long compresses, extended the length of the splints, or even by the immediate application of pasteboard on the limb. Long bandages are preferred, wherever it is requisite to establish a regular compression, and that the lifting of the injured part cannot entail inconvenience to the patient, sharp pain, derangement in the coaptation, &c. Short bandages are reserved for contrary cases ; they are disposed generally iti three planes, it is between the layer in contact with the skin and the middle layer, that the pasteboard splints are generally placed ; short bandages are especially employed in lesions of the pelvic extremity. The length or breadth of the bandages is proportioned to the part which ought to be covered by them. From the bandage which is applied immediately to the skin, more care is used than in the common bandage, to remove coarse edges, folds, irregular plaits ; folds should be repeated as seldom as possible ; these are kept as far as can be from the bony eminences, from excrescences, &c., which are first defended by some sob material, a layer of wadding, lint, &c., placed over or around these eminences, that besides are not entirely covered by all the bandages. These last precautions have for object to diminish the degree of pressure that the bandage could exercise more on them than on the soft parts, whose level these eminences.elcceed. Great care is taken that the bandages, and the containing apparatus generally, do not establish strangulation in some point of the length of the limb.