THE APPLICATION OF ABDOMINAL BANDAGES.
The indications for resort to retaining and compression bandages are: Relaxation of the abdominal walls; changes in the position and form of the internal genitals, in particular abnormal movability of the uterus and pendulous abdomen; every procedure after which the abdominal contents are rapidly lessened (removal of fluid from the abdomen, the end of labor, etc.); the presence of tumors which in the erect position cause pressure symptoms from their weight; inflammatory processes in or hyperesthesia of the abdominal walls, and finally hemorrhages. It is worthy of note that, as Hegar and Kaltenbach have shown, the application of an ab dominal bandage does not enforce a higher position on the diaphragm, and that, therefore, tympanitio distension may be controlled by means of the bandage.
In estimating the necessity of applying an abdominal bandage, we must be guided by the subjective sensations of the patient. There are certain patients who cannot wear a bandage, because it interferes with the respiratory act in a measure, and even increases pain ou account of sensibility of the skin, whence there result under the bandage, in par ticular, the moist, nutritive disturbances of the skin. These and similar results are, however, exceptional, and in the large proportion of cases gentle pressure and immobilization of the pelvic organs are exceedingly effective. Unpleasant results are more likely to be met with, because the bandage has not been properly applied. The exerted pressure may be unequal or too excessive, so that the circulation in the vessels of the abdomen or of the lower extremities is interfered with; the increase id the intra-abdominal pressure will often cause a deeper position of the uterus and of the ovaries, a downward sagging, to counteract which we must resort to vaginal or to perineal supporters.
Before the application of a dry bandage to the abdomen, the skin must be carefully cleansed, well dried, and covered with starch powder. In case a layer of cotton wool is first applied, then the skin should be greased with fat, vaseline, and the like, or else the cotton will stick to the skin and soon cause considerable pruritus. .
In case of patients who are confined to bed a sheet or roller bandage is used. The binder may be applied as follows: A towel, or linen or flannel, broad enough to extend from the ensiform cartilage to the pubes, and twice as long a.. the circumference of the body, is taken. This is passed under the patient, the ends drawn smoothly together, one end passed under the other, and the other end made fast. with safety pins. This bandage does not lie equally on the abdomen, and in order to obtain symmetrical pressure, cotton, jute, etc., must be packed under it, chiefly at the sides. In case it is desired to obtain greater pressure at a given spot, then we lay over this site a thick pad of cotton. If the patient be thin we must at the outset pad the lateral walls of the pelvis with cotton, else the pressure of the bandage on the iliac spines will be painful. This simple bandage limits the movements of the patient considerably, for the bandage readily slips upwards, and even where the patient keeps quiet it remains in place scarcely more than twenty-four hours. The bandage is removed in the reverse order from that in which it was applied.
The abdomen may also be encircled by a roller bandage of calico, flannel, and the like, about three and a half inches broad, or a many tailed bandage may be used. The roller bandage may be applied simple, or else with spiral turns. Each circlet must be sewed to its neighbor on the sides of the abdomen. Under each turn of the bandage it goes with out saying that cotton may be applied.
In order to allow patients to walk around wearing the simple ab dominal bandage, axilla and thigh bands may be attached to it, and thus it is prevented from slipping; but more frequently it is preferable to choose one of the ready-made abdominal supporters or girdles. These supporters do not aim usually at subjecting the abdomen to equable pressure, but rather at lifting up, supporting, the portion of the abdo men lying between the umbilicus and the symphysis.