to the front. Pin the crossed pieces and hang the hand in a sling (Pl. 13, Fig. 3).

Recurrent Bandage of the Head.-Take a roller two inches wide and six yards long. Make two circular turns horizontally around the forehead and head; when the middle of the forehead is reached, catch the bandage, take a half turn, carry the bandage to the occiput, let an assistant catch it, take a half turn, bring the roller forward to the forehead, covering a portion of the preceding turn; continue this process until the scalp is well covered; terminate with two circular turns around the forehead and head (Pl. 10, Fig. 3). It is often advisable to take a turn around the head and chin. Pin the crossed pieces.

Recurrent Bandage of a Stump.-Take a roller two inches wide and six yards long. Make two light circular turns around the root of the stump; make recurrent turns covering the stump as is done in covering the head; take a circular turn around the root of the stump, oblique turns to the top of the stump, circular turns around the tip, and apply an ascending spiral reversed bandage (Pl. 11, Fig. 5).

T-Bandage of the Perineum.-Pass the transverse part around the body above the iliac crests, and pin it in front; bring one of the tails over the dressing and up between the thigh and the genitals of one side, and the other tail over the dressing and up between the thigh and the genitals of the opposite side; secure these tails to the horizontal band.

Handkerchief Bandages.-Take unbleached muslin one yard square. The muslin folded once makes an oblong bandage; bringing its diagonal angles together makes a triangle bandage; a cravat is formed by folding a triangle bandage from summit to base; a cord is a twisted cravat. The triangle makes an admirable sling.

Fixed Dressings: Plaster-of-Paris Bandage.-Cover the

extremity with a cotton or flannel bandage or with a woollen stocking. Take a gauze roller infiltrated with plaster, and place it endwise in a basin of cold water, the water covering the plaster. When bubbles cease to come off, squeeze the bandage and apply it without much tension, smoothing out each turn with a moistened hand. As each bandage is taken from the basin, drop a fresh one into the water. Apply four thicknesses of bandage, and finish the dressing by sprinkling dry plaster over the bandage and smoothing it with wet hands. The ordinary plaster will set in from fifteen to thirty minutes. If it is desired to have it set more rapidly, put salt or alum in the water; if to have it set more slowly, pour stale beer into the water. The plaster bandage is removed by sawing it down the front or by moistening with dilute hydrochloric acid and then cutting through the moistened line with a strong knife.

Silicate-of-soda Dressing.-Protect the part as is done for a plaster bandage. Bandage the limb loosely with an ordinary muslin bandage, paint this bandage with silicate of soda, apply another bandage and paint it, and so on until six layers are applied. Gauze bandages soaked in silicate are better than ordinary bandages. Silicate dressings require from twelve to eighteen hours to dry, and they are removed by softening with water and cutting.

XXXIII. PLASTIC SURGERY.

Plastic surgery includes operations for the repair of deficiencies, for the replacement of lost parts, for the restoration of functions in parts tied down by scars, and for the correction of disfiguring projections. The following are the methods used:1

Displacement is the method of stretching or of sliding: 1 American Text-Book of Surgery.

(1) approximation after freshening the edges (as in harelip; (2) sliding into position after transferring tension to other localities (linear incisions to allow of stretching of the skin after large wounds). Interpolation is the method of borrowing material from an adjacent or a distant region. or from another person: (1) transferring a flap with a pedicle, which flap is put in place at once or is gradually gotten into place by a series of partial operations; (2) transplanting without a pedicle, which is performed by placing in position and by fixing there portions of tissue recently removed from the part, from another part of the same individual, or from a lower animal (as the button of bone after trephining, or in nerve-grafting), or by skin-grafting. Retrenchment is the removal of redundant material and the production of cicatricial contraction.

Skin-grafting.-In Reverdin's method the surface to be grafted should possess healthy granulations which are at the skin level. The grafts may come from the person to be grafted or from another person. Cleanse the skin from which the grafts are to come, the ulcer, and the skin about it, and, if corrosive sublimate is used, wash it away with a stream of warm normal salt-solution. Thrust a sewingneedle under the epidermis to lift it up, cut off the graft with a pair of scissors, and place the cut surface of the graft upon the ulcer. After applying a number of grafts place thin pieces of gutta-percha tissue over the grafts and extending on each side of the ulcer, and so placed as to allow drainage. This tissue, after being asepticized, is moistened with warm normal salt-solution (1 of 1 per cent.). Dress with a pad of aseptic gauze moistened with salt-solution; place over this gauze a rubber dam, and over the latter absorbent cotton and a bandage. In the case of children apply a light silicate bandage. Put the patient in bed. In forty-eight hours remove all the dressings except the gutta

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