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The essentials of bandaging / cover

The essentials of bandaging /

Chapter 62: CIRCUMCISION.
By Berkeley Hill
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About This Book

This practical manual provides concise, illustrated instructions for applying bandages and surgical apparatus, with chapters on materials, operator technique, bandaging of specific body regions, strapping methods, and management of fractures and dislocations of head, trunk, and limbs. It describes common turns and splints, approaches to immobilisation and extension, and offers procedures for dressing wounds, supporting stumps, and using elastic and plaster appliances. An appendix supplies lists of preparations, instruments, and items recommended for sick-room and operating-room use, presented as checklists to help students and practitioners refresh practical skills.

INSTRUMENTS, &c., FOR OPERATIONS ABOUT THE TRUNK.

Removal of the Breast or Tumours. Extirpation of the Cervix Uteri.
Nævus. Amputation of the Penis.
Tapping the Pleura. Circumcision.
Tapping the Belly. Excision of Testis.
Colotomy. Tapping a Hydrocele.
Ovariotomy. Vesico-Vaginal Fistula.
Cæsarian Section. Retention of Urine.
Strangulated Hernia. External Urethrotomy.
Radical Cure of Hernia. Lithotomy.
Hæmorrhoids. Lithotrity.
Fistula in Ano. Removing Foreign Bodies from the Urethra and Bladder.
Cleft Perinæum.

REMOVAL OF THE BREAST OR TUMOURS.

1. Scalpel. 10. Wire or silk sutures.
2. Artery forceps. 11. Lint.
3. Torsion forceps. 12. Diachylon plaster.
4. Dissecting forceps. 13. Sponges.
5. Double hook. 14. Scissors.
6. Blunt hooks. 15. Three-inch wide rollers.
7. Tenaculum. 16. Folded towel compress.
8. Fine ligatures. 17. Chloroform and inhaler.
9. Half-yard of stout whipcord, for irremovable glands. 18. Waterproof sheet.

NÆVUS.

For Ligature.

1. Nævus needles, straight and curved. 5. Lint.
2. Suture silk, stout compressed whipcord. 6. Chloroform and inhaler.
3. Scalpel. 7. Sponge and water.
4. Scissors.

For Cauterising.

1. Acupressure needles. 3. Galvanic cautery.
2. Spirit lamp. 4. Gas cautery.

For Excising.

1. Scalpel. 6. Ligature.
2. Dissecting forceps. 7. Lint.
3. Blunt hooks. 8. Bandage.
4. Artery forceps. 9. Sponge.
5. Sharp hooks. 10. Sutures.

For Injecting.

1. Subcutaneous injecting syringe. 2. Solution of perchloride of iron.

For Passing Setons.

1. Small fine suture needles. 2. Fine silk suture.

TAPPING THE PLEURA.

1. Small scalpel. 5. Collodion.
2. Trocar, fitted with india-rubber tube. 6. Strapping.
3. Bucket. 7. Scissors.
4. Lint. 8. Brandy.

TAPPING THE BELLY.

1. Body bandage (see p. 10). 6. Scissors.
2. Scalpel. 7. Lint.
3. Trocar. 8. Bucket.
4. Suture. 9. Diachylon plaster.
5. Collodion. 10. Brandy.

AMUSSAT’S OPERATION OF COLOTOMY AND GASTROTOMY.

1. Scalpel. 9. Retractors.
2. Probe-pointed bistoury. 10. Sponges.
3. Director. 11. Large trocar.
4. Dissecting forceps. 12. Tow.
5. Nævus needle, threaded with thick whipcord. 13. Sponges.
6. Silver sutures. 14. Large syringe full of warm water.
7. Artery forceps. 15. Chloroform and inhaler.
8. Fine ligatures.

OVARIOTOMY.

1. Room raised to temperature of 70° F. 13. Wire nippers.
2. Scalpel. 14. Strong whipcord.
3. Clamp. 15. Silk sutures and silver wire.
4. Vulcanised india-rubber tubing, to fix on cannula. 16. Diachylon plaster.
5. Torsion forceps. 17. Catheter for emptying the bladder.
6. Artery forceps and ligatures. 18. Soft napkins.
7. Fine ligatures. 19. Bandage or laced napkin.
8. Broad retractors. 20. Chloroform and inhaler.
9. Blunt hooks. 21. Cautery iron.
10. Ovariotomy trocar. 22. Silver pins.
11. Nævus needles, threaded. 23. Sponges.
12. Hare-lip pins.

CÆSARIAN SECTION.

1. Room maintained at temperature of 70° F. 11. Hare-lip pins, stout and long.
2. Catheter to empty bladder. 12. Suture silk.
3. Large scalpel. 13. Fine sutures.
4. Straight probe-pointed bistoury. 14. Folded linen compress.
5. Director. 15. Broad body roller.
6. Large blunt hooks. 16. Flannel.
7. Large syringe and vaginal tube, for washing out uterus per vaginam. 17. Cotton wool.
8. Artery forceps. 18. Warm flannels.
9. Ligatures, fine and stout whipcord. 19. Chloroform and inhaler.
10. Torsion forceps.

STRANGULATED HERNIA.

1. Scalpel. 12. Ligatures.
2. Straight bistoury. 13. Sutures.
3. Probe-pointed bistoury. 14. Lint.
4. Hernia knife. 15. Diachylon plaster.
5. Narrow director. 16. Three-inch wide roller.
6. Broad director. 17. Compress.
7. Dissecting forceps. 18. Razor.
8. Blunt hooks. 19. Sponges.
9. Fine hook, in case the sac is very tense. 20. Half grain of morphia suppository.
10. Artery forceps. 21. Chloroform and inhaler.
11. Torsion forceps. 22. Scissors.

WOOD’S OPERATION FOR RADICAL CURE OF HERNIA.

1. Razor, or scalpel, for shaving the groin. 7. Lint.
2. Tenotomy knife. 8. Bandage.
3. Needle. 9. Scissors.
4. Compressed whipcord, well waxed and soaped. 10. Suture.
5. Glass or box-wood compress. 11. Collodion.
6. Two pads of lint.

HÆMORRHOIDS.

External,—Excision of.

1. Vulsellum, or hook, or ringed forceps. 4. Lint and T-bandage.
2. Knife-edged scissors curved on the flat. 5. Smith’s clamp.
3. Torsion forceps. 6. Cautery iron.

Internal.

1. Enema of warm water. 6. Smith’s clamp.
2. Hook, vulsellum, or ring-forceps. 7. Ice.
3. Thin compressed whipcord. 8. Solid perchloride of iron.
4. Nævus needles threaded, to transfix the base of the pile. 9. Lint and cotton wool.
5. Scissors. 10. Opium suppository.

PROLAPSUS ANI.

The same.

FISTULA IN ANO.

1. Probes of various sizes, some grooved. 9. Stout ligature.
2. Grooved director. 10. Cautery iron.
3. Probe-pointed curved bistoury. 11. Lint, cotton wool.
4. Straight sharp-pointed bistoury. 12. Sponges.
5. Tenaculum. 13. Compress.
6. Threaded curved needle set in a handle. 14. Three-inch wide roller.
7. Torsion forceps. 15. Oil.
8. Artery forceps. 16. Chloroform and inhaler.

CLEFT PERINÆUM.

1. Scalpel. 7. Glass rods, or No. 12 bougies.
2. Hook forceps. 8. Collodion.
3. Curved nævus needles, threaded. 9. Lint.
4. Stout whipcord. 10. Sponges on handles.
5. Suture silk. 11. Oil.
6. Wire suture. 12. Chloroform and inhaler.

EXTIRPATION OF THE CERVIX UTERI.

1. Two hooked forceps, or long vulsella. 13. Hare-lip pins.
2. Specula (bivalve and duckbill). 14. Dentists’ silk.
3. Ecraseur. 15. Cautery irons.
4. Two wool holders. 16. Perchloride of iron.
5. Small sponges on sticks. 17. Solution of chloride of zinc.
6. Scalpel. 18. Ice.
7. Straight probe-pointed bistoury. 19. Lint (if plugging necessary, see pp. 127, 128).
8. Bistoury curved on the flat. 20. Compressed sponge in pieces.
9. Long-handled straight scissors. 21. Soft silk handkerchief.
10. Long-handled curved scissors. 22. Cotton wool.
11. Artery forceps. 23. Suppository.
12. Ligatures.

AMPUTATION OF THE PENIS.

1. Tape to tie round the root of penis. 8. Fine ligatures.
2. Straight bistoury. 9. Fine suture, to fix the flap of mucous membrane of the urethra.
3. Scalpel. 10. Flexible catheter.
4. Artery forceps. 11. Lint.
5. Torsion forceps. 12. Tape.
6. Dissecting forceps. 13. Ice.
7. Scissors. 14. Chloroform and inhaler.

CIRCUMCISION.

1. Small straight bistoury. 7. Torsion forceps.
2. Polypus forceps. 8. Scissors.
3. Half-inch wide tape. 9. Lint.
4. Artery forceps. 10. Ice.
5. Fine ligatures. 11. Chloroform and inhaler.
6. Silk suture.

EXCISION OF TESTIS.

1. Scalpel. 6. Artery forceps.
2. Large sharp hook. 7. Sutures, silk or wire.
3. Blunt hooks. 8. Scissors.
4. Stout whipcord. 9. Chloroform and inhaler.
5. Fine ligature. 10. Lint.

TAPPING AND INJECTING A HYDROCELE.

1. Trocar. 5. Lint.
2. Vulcanite syringe, with nozzle to fit cannula. 6. Collodion.
3. Tincture of iodine. 7. Plaister.
4. Suspender for the testicles.

VESICO-VAGINAL FISTULA.

1. Duckbill speculum. 14. Lead clamp.
2. Scalpels set in long handles, curved blades. 15. Awl for perforating the clamp.
3. Long-handled curved scissors. 16. Clamp adjuster.
4. Long-handled forceps. 17. Split shot.
5. Long-handled hooked forceps. 18. Forceps for placing and pinching the shot.
6. Long-handled sharp hook. 19. Small sponges set on slips of wood.
7. Narrow curved spatula. 20. Large sponges.
8. Needles to carry silver wire suture. 21. Sims’ catheter.
9. Silver wire. 22. Ice-cold water.
10. Probes. 23. Syringe and flexible catheter for injecting the bladder, to test the perfect closure of the fissure.
11. Short curved needles, to carry fine silk suture. 24. Chloroform and inhaler.
12. Needle holder. 25. Oil.
13. Suture tightener.

RETENTION OF URINE.

1. Flexible catheters (Nos. 8 to ½) (English and French). 8. Tapes and string.
2. Finest gum bougies (No. ¼). 9. Strapping plaister.
3. Silver catheters. 10. Scissors.
4. Long prostatic catheter. 11. Trocar for tapping per rectum.
5. Oil. 12. Tincture of opium.
6. Glass syringe. 13. Morphia suppository.
7. Injecting bottle. 14. Chloroform and inhaler.

EXTERNAL URETHROTOMY.

1. Scalpels. 10. Tapes.
2. Catheters, silver. 11. Sponges.
3. Catheters, flexible. 12. Tenaculum.
4. Four feet of india-rubber tubing to fit catheter. 13. Artery forceps.
5. Probes, straight and grooved, with flat handles. 14. Ligatures.
6. Syme’s shouldered narrow grooved staff. 15. Oil.
7. Marshall’s long jointed grooved sound, with flexible catheter sliding on it. 16. Ice.
8. Curved director. 17. Chloroform and inhaler.
9. Lithotomy tapes or anklets.

LITHOTOMY.

1. Firm table, of convenient height. 15. Syringe, various nozzles.
2. Folded blankets. 16. Gorget.
3. Mackintosh sheet. 17. Tubes, with and without petticoats.
4. Tray of sand, or saw-dust. 18. Lithotrite.
5. Pair of lithotomy tapes, or anklets. 19. Catheter to fit syringe.
6. Lint. 20. Artery forceps.
7. Sound. 21. Tenaculum.
8. Staff. 22. Ligatures.
9. Catheter to fit syringe, for injecting the bladder. 23. Half grain morphia suppository.
10. Lithotomy scalpels. 24. Chloroform and inhaler.
11. Forceps. 25. Oil.
12. Scoops. 26. Sponges.
13. Searcher. 27. Bandages and tape.
14. Bistouri caché. 28. Brandy, ammonia.

LITHOTRITY.

1. Lithotrites, fenestrated and flat. 6. Urethral forceps.
2. Hollow sound, with short beak. 7. Injecting bottle, with nozzle to fit the hollow sound.
3. Clover’s apparatus for washing out the bladder. 8. Half grain morphia suppository.
4. Oil. 9. Hot linseed poultice.
5. Lithotrite catheters. 10. Firm bolster or pillow.

REMOVING FOREIGN BODIES FROM THE URETHRA AND BLADDER.

1. Catheters, silver, gum, elastic. 15. Three-branched forceps.
2. Sounds of different curves. 16. Endoscope.
3. Bougies olivaires. 17. Oil.
4. Urethral forceps with long blades. 18. Glass syringe.
5. Fine dressing forceps. 19. Scalpel.
6. Fine polypus forceps. 20. Dissecting forceps.
7. Coxeter’s urethral forceps. 21. Hook.
8. Urethral lithotrite forceps. 22. Artery forceps.
9. Hunter’s tube forceps. 23. Ligature.
10. Loop of wire set in long handle. 24. Sutures.
11. Leroy d’Etiolles’ jointed scoop. 25. Tapes.
12. Leroy’s tube, and sliding hook. 26. Sponges.
13. Charrière’s hair-pin retractor. 27. Chloroform and inhaler.
14. Charrière’s bougie retractor.

INSTRUMENTS FOR OPERATIONS ON THE LIMBS.

Ligature of the Larger Arteries. Amputations at the Shoulder-Joint, Joint, Arm, Forearm and Wrist; Metacarpus, Hip, Thigh and Leg; by Syme’s and Chopart’s Operations; Metatarsus.
Resections, of the Head of the Humerus, Elbow, Hip, and Knee.
Removal of Necrosed Bone.

LIGATURE OF THE LARGE ARTERIES.

1. Scalpel. 11. Artery forceps.
2. Grooved director. 12. Fine ligatures.
3. Dissecting forceps. 13. Sutures.
4. Broad grooved director. 14. Scissors.
5. Probe. 15. Sponges on sticks.
6. Blunt hooks. 16. Larger sponges.
7. Metallic retractors. 17. Strapping.
8. Aneurism needle. 18. Lint.
9. Ditto, helix curve. 19. Bandage.
10. Waxed compressed whipcord. 20. Chloroform and inhaler.

RESECTION OF THE SHOULDER.

1. Scalpels. 12. Sutures.
2. Saw (Irish bow-saw). 13. Key to compress the subclavian artery.
3. Retractors. 14. Cautery iron.
4. Lion’s-tooth forceps. 15. Wire nippers.
5. Blunt hooks. 16. Lint.
6. Artery forceps. 17. Bandages.
7. Torsion forceps. 18. Strapping.
8. Tenacula. 19. Oiled silk.
9. Acupressure needles. 20. Sponges.
10. Linen retractors. 21. Mackintosh sheet.
11. Ligatures. 22. Chloroform and inhaler.

RESECTION OF THE ELBOW.

1. Straight bistoury. 11. Ligatures.
2. Retractors. 12. Sutures.
3. Blunt hooks. 13. Lint.
4. Bow-saw. 14. Oiled silk.
5. Probes. 15. Bandages.
6. Gouges. 16. Strapping.
7. Torsion forceps. 17. Sponges.
8. Artery forceps. 18. Mackintosh sheet.
9. Lion’s-tooth forceps. 19. Angular splint to support the arm.
10. Bone forceps. 20. Chloroform and inhaler.

RESECTION OF THE UPPER END OF THE FEMUR.

1. Strong bistoury. 11. Torsion forceps.
2. Probe-pointed bistoury. 12. Tenaculum.
3. Long probes. 13. Ligatures.
4. Bow-saw. 14. Sutures.
5. Retractor. 15. Bandages.
6. Blunt hooks. 16. Lint.
7. Narrow linen retractor. 17. Sponges.
8. Gouges and chisels. 18. Straight bracketed long splint and pads.
9. Bone forceps. 19. Chloroform and inhaler.
10. Artery forceps. 20. Mackintosh sheet.

RESECTION OF THE KNEE.

1. Straight bistoury. 11. Ligatures.
2. Scalpels. 12. Sutures.
3. Metallic retractors. 13. Tourniquet.
4. Bow-saw. 14. Sponges.
5. Gouge. 15. Lint.
6. Chisel. 16. Bandages.
7. Artery forceps. 17. Oiled silk.
8. Torsion forceps. 18. McIntyre’s splint and pads.
9. Acupressure needle. 19. Chloroform and inhaler.
10. Tenaculum. 20. Mackintosh sheet.

REMOVING NECROSED BONE.

1. Scalpels. 13. Artery forceps.
2. Straight and curved bistouries, with sharp and probe points. 14. Tenaculum.
3. Long and short probes. 15. Torsion forceps.
4. Directors. 16. Acupressure needles.
5. Retractors. 17. Ligatures.
6. Gouges. 18. Sutures.
7. Chisels. 19. Lint.
8. Bone forceps (various). 20. Bandages.
9. Gouge forceps. 21. Oiled silk.
10. Sequestrum forceps. 22. Mackintosh sheet.
11. Lion’s-tooth forceps. 23. Chloroform and inhaler.
12. Osteotrites.

AMPUTATION AT THE SHOULDER JOINT.

1. Tourniquet. 10. Strapping cut into strips.
2. Long amputating knife. 11. Bandages.
3. Artery forceps. 12. Lint.
4. Fine ligatures, stout ligatures. 13. Oiled silk.
5. Tenaculum. 14. Sponges.
6. Acupressure needles. 15. Cautery irons.
7. Needle nippers. 16. Ice.
8. Key to compress subclavian artery. 17. Mackintosh sheet.
9. Sutures. 18. Chloroform and inhaler.

AMPUTATION OF THE ARM.

1. Tourniquet. 13. Bandages.
2. Amputating knife. 14. Wadding.
3. Saw. 15. Straight splints.
4. Artery forceps. 16. Sponges.
5. Torsion forceps. 17. Mackintosh sheet.
6. Ligatures. 18. Chloroform and inhaler.
7. Sutures. If a circular amputation—
8. Tenaculum.
9. Acupressure needles. 19. Split linen retractor; and
10. Wire nippers. 20. Round-pointed straight-edged knife.
11. Strapping.
12. Lint.

AMPUTATION OF THE FOREARM AND WRIST.

1. Tourniquet. 10. Sutures.
2. Large bistoury, or small amputating knife. 11. Lint.
3. Torsion forceps, artery forceps, and ligature thread. 12. Wool.
4. Artery forceps. 13. Splints.
5. Saw. 14. Bandages.
6. Acupressure needles. 15. Oiled silk.
7. Needle nippers. 16. Sponges.
8. Tenaculum. 17. Mackintosh sheet.
9. Fine ligatures. 18. Chloroform and inhaler.

AMPUTATION OF METACARPAL BONES AND PHALANGES.

1. Narrow-bladed bistoury. 10. Splint to support the arm and hand.
2. Bone forceps. 11. Bandage.
3. Torsion forceps. 12. Lint.
4. Artery forceps. 13. Oiled silk.
5. Fine ligatures. 14. Mackintosh sheet.
6. Small suture. 15. Sponges.
7. Strapping. 16. Tourniquet.
8. Narrow bandage. 17. Chloroform and inhaler.
9. Wadding.

AMPUTATION AT THE HIP JOINT.

1. Lister’s aorta compressor. 10. Lint.
2. Long hip knife. 11. Strapping plaister.
3. Artery forceps. 12. Sponges.
4. Stout and fine ligatures. 13. Bandages.
5. Torsion forceps. 14. Ice.
6. Tenaculum. 15. A bone-holder, or lion’s-tooth forceps, if the fragment of the bone is too short to grasp in the hand.
7. Acupressure needles. 16. Chloroform and inhaler.
8. Needle nippers. 17. Mackintosh sheet.
9. Silk and silver sutures.

(See also the List for the Operating Room).


AMPUTATION OF THE THIGH AND LEG.

1. Tourniquet. 15. Bandages.
2. Amputating knife. 16. Oiled silk.
3. Scalpel. 17. Cautery iron.
4. Bone forceps. 18. Ice.
5. Saw. 19. Sponges.
6. Torsion forceps. 20. Mackintosh sheet.
7. Artery forceps. In a circular amputation—
8. Stout and fine ligatures.
9. Sutures. 21. A round-pointed knife, and a linen retractor split into two tongues for the thigh and three for the leg, the centre one being well waxed.
10. Tenaculum.
11. Strapping.
12. Hare-lip pins.
13. Wire nippers.
14. Lint.

AMPUTATION AT THE ANKLE AND FOOT.

(Syme’s and Chopart’s Operations.)

1. Tourniquet. 11. Strapping.
2. Strong bistoury. 12. Sutures.
3. Strong scalpel (Syme’s). 13. Lint.
4. Saw. 14. Bandages.
5. Bone forceps. 15. Oiled silk.
6. Artery forceps. 16. Wool.
7. Torsion forceps. 17. Sponges.
8. Tenaculum. 18. Chloroform and inhaler.
9. Acupressure needles. 19. Mackintosh sheet.
10. Wire nippers.

AMPUTATION OF THE METATARSAL BONES AND TOES.

1. Tourniquet. 10. Lion’s-tooth, or sequestrum forceps.
2. Straight bistoury. 11. Strapping.
3. Tenaculum. 12. Lint and wool.
4. Torsion forceps. 13. Bandages.
5. Acupressure needles. 14. Narrow saw.
6. Needle nippers. 15. Bone forceps.
7. Artery forceps. 16. Mackintosh sheet.
8. Ligatures. 17. Chloroform and inhaler.
9. Sutures.