Wednesday, September 16, 2009

Historical Surgical Dressings

The surgical dressings section of the old surgery text, A Text-Book of Minor Surgery by Edward Milton Foote, MD, I first mentioned on Monday is very interesting.
Cotton in its raw state has very little absorbent power because of the oil and gum with which its fibers are covered. When the cotton has been bleaches by chemicals, and the oil extracted, its absorbent power is very great. This fact, together with its cheapness and lightness, the toughness of its fiber, and its ready sterilization by steam or dry heat make it almost the ideal material for surgical dressings.
Unbleached Cotton
This is cotton in its natural state, freed from dirt, combed, and put up in pound rolls. It is non-absorbent and has a greater elasticity than the absorbent cotton. It is therefore preferable as a padding for splints, and to diffuse the pressure of a non-elastic bandage….It costs about thirty five cents a pound…..
Absorbent Cotton
as supplied by the manufactures of surgical dressings, is freed from dirt, gum, and oil, combed and sterilized, and so wrapped in tissue-paper that with a little care it remains aseptic until it is all used. It is furnished in packages of various sizes, from a half ounce to one pound, costing thirty-five cents a pound in pound packages. On account of its lack of elasticity, it is inferior to unbleached cotton as a padding for splints, etc.
Dry cotton is not a suitable material to bring into contact with a wound either during operation or afterward. In the former case its fibers are likely to stick to the wound, and also to the fingers of the operator. In the latter case, if the discharge is small, it is likely to evaporate and seal the cotton to the wound or to the surrounding skin with a scab which is difficult of removal. If cotton is used for sponging, during an operation, balls of suitable size should first be saturated with saline or some antiseptic solution, and then squeezed dry.
Substitutes for Cotton
Lamb’s Wool
Lamb’s wool has great elasticity, does not become soggy when exposed to moisture, and absorbs readily oily substances and glycerids. When cleaned and sterilized it is therefore an excellent material for vaginal tampons.
[So very different from today!]
Bleached absorbent gauze is the most important item in surgical dressings. The firmness of the material varies according to the number of threads to the inch. The quality should be selected according to the purpose for which it is desired. Thus a gauze which has 24 X 32 threads to the square inch is suitable for sponges or for dressings, but has not sufficient firmness to make a good bandage. On the other hand, a gauze with 40 X 44 threads to the square inch, used for bandages, is unnecessarily expensive when used for sponges or dressings. It is, however, an unwise economy to select for sponges and dressings a gauze with too large a mesh. Such a gauze absorbs so little that an additional quantity is required in every case, so that the total expense is very likely increased.
Gauze suitable for sponges and dressings, have 26 X 32 threads to the four to five cents a yard, by the piece of 100 yards. This price is increased to eight or even ten cents a yard when the gauze is purchased in small pieces, previously sterilized and hermetically sealed.
Unbleached Muslin
Muslin, bleached, or more often unbleached, is used for slings, for handkerchief or first aid dressings, and for roller bandages.
The muslin employed for bandages need not be of the best quality, since even the cheaper grades are sufficiently firm for the purpose. Such a muslin costs about eight cents a yard, by the piece. A muslin bandage has certain points of superiority over gauze. It is firmer and will maintain its shape for a long time if well put on. It is not so easily soiled, and can be washed and ironed and used again many times. This is often an item of importance in dressing chronic ulcers of the leg, etc., as patients with such diseases are often obliged to practice rigid economy. Muslin tears readily, with a fairly sharp edge, so that the homemade bandages present a good appearance.
[Can you imagine reusing dressings like this? Would you ask yourself or your nurse to wash and iron the muslin for tomorrow’s dressing change?]
The flannel selected for bandages need not be finely woven, but it should be all wool, in order to give the bandage its maximum of elasticity, which is the special merit of this type of bandage. The chief objection to a flannel bandage is its expense. It can be repeatedly washed and dried, provided lukewarm water and mild soaps are used, so that it is especially useful as a bandage of the legs, for chronic ulcer associated with edema. Whether red flannel or white flannel is employed is a matter of taste. The former has no superiority to the latter, and the dye sometimes comes out and stains the skin. Flannel bandages are easily torn, or they may be cut on the bias, the elasticity being thereby considerably increased. The latter form of bandage tends to become narrower with use – a point which should be taken into consideration in cutting the bandage. A patient should be directed to purchase two yards of flannel, every thread of which is wool, cut it on the bias into strips four inches wide, lay the ends of these, and sew them together flat, in order to avoid unnecessary ridges. This will give him three bandages, so that he can wash one while the other two are in use. A similar plan may be followed in making torn flannel bandages, although if one wants as many as six or eight, he will naturally use a piece of flannel as long as the bandage required. Flannel suitable to this purpose costs at retail about forty cents per yard and is about twenty-eight inches wide.
[I find this whole description of making bias flannel bandages wonderful, but especially the concern over the skin staining from the red dye.]
Canton Flannel
Canton flannel is used chiefly for making many tailed bandaged and other bandages of the abdomen. It is too thick to make a satisfactory bandage of an extremity or the head. It has no elasticity. It tears well, and costs about twelve cents a yard at retail.
Stockinette is a cotton fabric knitted in cylindrical form. It is sometimes employed for bandages on account of its elasticity. It can be washed and used repeatedly, but its thickness makes it a very clumsy material, and it is as expensive as flannel, costing twenty-five cents per bandage of five yards.
Large cylinders of stockinette are used instead of an undershirt to prevent a gypsum or plaster of Paris from coming into contact with the skin. One yard or more of the material is cut off, and near one end two holes are cut for the arms. Thus all seams and buttons are avoided.
Gutta-percha Tissue
This material is gutta-percha spread into thin sheets, and treated in such a manner that its surface is not sticky. It is sold in sheets a yard square, and costs from fifty to sixty cents a yard, according to the weight, whether light, medium, or heavy. For certain purposes this is the best impervious material that we have. It is absolutely non-irritating to the skin or to the wound, or to a mucous membrane. It never adheres to a wound, and for that reason makes an excellent drain when folded upon itself to make a narrow strip, or when it is used to cover a slender roll of gauze. It is often employed in burns and skin-grafts, to keep the wounded surface moist, and to protect it from contact with the dressing. Unfortunately, it cannot be sterilized by heat, as it shrivels up when placed in water even a little above the temperature of the body. it is commonly sterilized by immersion in a strong bichlorid solution for some time before its employment. Before it is used it should be rinsed with saline solution or sterilized water.
Oiled Muslin, Silk, and Paper
As now prepared, oiled muslin has none of the sticky, disagreeable features formerly attached to both oiled muslin and silk. It is flexible, opalescent, and costs about seventy-five cents a square yard. Oiled silk prepared in the same manner, but only thirty inches wide, costs a dollar a yard. These materials are serviceable to prevent evaporation from a poultice or wet dressing, and to prevent saturation of the bed clothing or clothing of the patient during the continuance of a wet dressing. Cheaper grades of oiled muslin can sometimes be obtained in dry-goods stores. Oiled paper makes a fairly good substitute for oiled muslin, and costs only three cents a yard by the roll of twenty-five yards. It is twenty-four inches wide.

1 comment:

ER's Mom said...

Makes me grateful for J&J bandaids.

Red flannel - no need to worry about staining the cloth! ;)