Gum thickened with powdered chalk, glue, silicate of soda, Hides’ leather felt and stiffening solution, paraffine, &c., are also employed for stiffening bandages and flexible splints, after they are moulded to a limb, but none of them are as readily procured or have much advantage over starch and plaster of Paris. A detailed description of the mode of using them is unnecessary.

Sand-bags are very useful, when laid along an injured limb, to prop it up on either side. For this purpose they are better than pillows, as their weight prevents their slipping from under the part they support. They should be made of macintosh cloth about 4 or 6 inches diameter, and in lengths varying from 1 to 4 feet, well closed that the sand may not escape through the seams; the macintosh should be covered with flannel, renewed from time to time. The sand should be washed and well dried before the bags are filled, that it may not rot the cloth containing it. Moreover, the bags should be only three quarters full, or they will be too hard to adapt themselves to the limb when in use.

Cradles are light arched frames of wire or cane to support the bedclothes over an injured limb. On emergency an efficient cradle can be constructed from a band-box, by knocking out the bottom and putting the leg through it. If used to protect a foot, a notch may be cut with strong scissors, not a knife, for that splits the wood.

If the cradle is stout enough, it is useful to sling a broken limb in its splint, and often great relief is thus given to the patient. Dr. Salter’s Swing Cradle is specially contrived for the purpose, and is shown, fig. 42, page 64.

Leather Splints.—For these sole leather, to be purchased at any leather dealer’s, is used. In preparing them, the required length should be first noted down, then a series of transverse measurements taken at the widest and narrowest parts of the limb and over the projections of joints, &c., or a pattern may be first cut in paper and laid on the sheet of leather from which a corresponding piece is cut. The splint should always be so arranged that its edges do not bear on any bony point, the shin, or malleoli, for example, but either fall short of or pass beyond them. The hair side of the leather should go next the skin, as it is the smoothest and least irritating. The edges of the splint must be thinned by bevelling off the outside for about an inch all round, and no sharp corners should be left. When the leather is prepared it should be soaked, if the time can be spared, for twenty-four hours in cold water, but when wanted quickly it can be softened in a few minutes by soaking it in warm water to which a little vinegar is added—this, however, renders the leather brittle when dry, and apt to curl at the edges. When the leather is softened, a very thin even layer of cotton wadding or of lint is laid on next the skin; the splint is then moulded to the limb with the hands, and bandaged firmly; in twelve hours it will be dry and rigid. The roller is then unwound, and any parts of the splint pressing on bony projections are marked before removal. It is then trimmed, and laid between two layers of wash-leather stitched together round the edges. The splint is now finished, and can be either fastened on by a roller or by two or more straps and buckles stitched to it.

When support is required for a joint, the splint should be fitted on the sides, where the leather may have the rigidity of its width rather than only that of its thickness to prevent bending.

Leather Splint for the Hip.—This joint is by far the most difficult to fit. The hip splint should obtain a good grasp of its fixed point, the pelvis, and a stiff bearing on the front of the thigh where its pressure is to be exerted. There are many plans of procuring a satisfactory fit; the following is one of the best.

First cut a pattern on a sheet of paper from which to shape the leather. If possible the patient should stand while the pattern is fitting. Take a sheet of paper large enough to reach round the body, and long enough to extend from the waist to the leg below the knee. Lay it against the diseased hip, carry its vertical margin a little beyond the middle line in front towards the sound side, and the other part round the body behind, till the front is reached on the sound side. Feel for the anterior iliac spine, and mark with a pencil the point midway between it and the pubis; from this draw one horizontal line inwards to the border of the paper, and a second obliquely to the perinæum. Then seek for the junction of the sacrum and iliac bone behind, which corresponds pretty nearly to the point first found in front; from this mark the gluteal fold. Next carry a line vertically from the upper border of the sheet of paper to the great trochanter; and lastly, mark the level of the pelvis. Lay the sheet on a table and slit it with scissors along the lines marked, apply it a second time to the body and bend the thigh part round the thigh, making its anterior margin reach well to the inside of the limb, while the posterior part should almost meet it from behind. The splint should also reach downwards to the back of the knee. The paper is then trimmed down to these dimensions. The hip part is next trimmed so that it clears the buttock on the sound side and passes round to the anterior iliac spine of that side. The pattern being complete, cut a piece of sole-leather to correspond, arranging that the hair or short side of the leather will lie next the skin; bevel off the outer edge all round, and soak the leather till thoroughly soft in water, wipe it dry, and bandage it carefully first to the trunk and next to the thigh. When it is set, superfluous and overlapping edges must be marked before removal; lastly, the sides of the vertical notch, between the hip and trochanter, are stitched together, and the splint is covered with wash-leather.

When extension of the hip is required (see page 80), it can be applied to the leg below the splint without lessening the support that affords.

The accompanying figure, 59, is drawn from a splint fitted by Mr. Heather Bigg on the plan just described.

Gutta-Percha may always be substituted for leather in these splints, and the same plan of fitting is used, except that the notching requisite in leather is not necessary in using gutta-percha; for the directions to use this material see page 50.