Such bandages are also of use in order to exert, by means of a mova ble cushion, circumscribed pressure on the abdomen. Any apparatus which is worn in order to exert methodical pressure on any organ, such as an ovary or a movable kidney, should be constructed after the manner of Charriere's hypogastric girdle. As the action of the previously de scribed abdominal bandage consists especially in causing an increase of the intra-abdominal pressure, so do we endeavor by means of this cush ion to take a portion of the pressure off the uterus, the cushion being applied so that its lower border projects forcibly against the abdominal cavity. These cushions are oval, heart or kidney-shaped, and are con structed of wood, hard-rubber, or metal, covered with leather or stuffed.
They are either attached to a stuffed abdominal girdle, so that traction may be made in the horizontal long axis, or else, as in G. Braun's band age, they are attached to an elastic or inelastic bandage to which thigh straps are adapted. Braun's cushion has a sharply projecting protube rance at its lower border which makes up for the lack of distensibility of the cushion in its long axis. (Fig. 132.) The pad, as in Trier's apparatus, is also held in place by springs, like those adapted to trusses, and the American bandages in particular are constructed so that the abdominal pad is held in place by a truss spring on each side, the anterior and posterior extremities of which have adapted to them a round, oval, or long slender cushion. The pressure from this apparatus is only exerted on the anterior lower portion of the abdomen, and on the lumbar region. These supporters are generally well borne, and answer their purpose if only the abdominal pad retains a part of its movability.
Other bandages are in use to keep pads over the external genitals in plaee, or to afford support to the relaxed middle segment, or to hinder the prolapse of the vaginal walls or of the uterus outside of the vulva, and frequently to increase the support of the pelvic floor where vaginal pessaries are inserted. The T-bandage used even by Hippocrates in case of prolapsus ani consists essentially of an abdominal girdle, attached to which anteriorly and posteriorly is a napkin which passes between the thighs. This simple T•bandage is now only used provisionally as a sup porter, since the wearing is associated with many disadvantages. The various vulvo-perineal apparatuses are without question more preferable, and they are constructed on the principle of a double T-bandage. Such
apparatuses have been devised by Jones, Hull, Nunn, Piorry, C. Braun, Noeggerath and many others. Essentially they all depend on the prin ciple of supporting the perineum by means of a round, oval, or cone shaped pad, or cushion. This pad is attached to the abdominal binder by four straps or bands, two in front and behind respectively, which may be unyielding or elastic, or formed of a double truss (C. Braun). When using this apparatus, the -abdominal portion is first applied, and then the pad is pushed over the perineum from behind, so that the introitus vulvae is diminished from behind forwards, and then the lateral straps are attached to the abdominal bandage and lastly to the other ends.
These supporting apparatuses are only very exceptionally used, for, on.the one hand, the better-constructed pessaries, and, on the other, the plastic operations on the vagina and the perineum, have greatly limited their sphere of utility.
In order to maintain the smaller and lighter supports over the exter nal genitals, strips of plaster may also snbserve a useful purpose. Occa sionally plaster itself, as, for instance, ung. diachyli, in case of pruritus or eczema, is applied over the parts around the vulva. In these instances, of course, the hair must be shaved from the parts. A simple or a double spinous crutch may also be used in order to maintain a pad in position, or in order to exert compression to one side of the vulva. The objection to a bandage of this sort does not depend so much on the difficulty of ap plying it, as on the fact that the urethra and the vulva must be left open, and, further, in that it readily becomes soiled. It is well here, as in case of other appliances during the wearing of which the douche must be used, to place a piece of rubber cloth under it, and then when the ap paratus is in place, to cover it over with the projecting portions of this rubber. Vulvar bandages are further used during menstruation to re ceive the discharge, or else, aside from the menstrual period, in case of leucorrhea, and also in case of patulous vulva to disinfect the entering air. These bandages generally consist of slender cushions, about four inches long, which are filled with sublimated or salicylated mineral wool, or jute, etc., and which are attached to a pelvic girdle or to an abdominal supporter.