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March 24, 2015

Mayor to Esmarch to Johnson: The history of the Triangular Bandage

Most first aid kits today include a triangular bandage as a standard inventory item. Just a simple piece of cloth or similar material cut into a triangle shape with a broad base and two smaller sides.

Take a training class in first aid today and chances are there is little to no information about what a triangular bandage is for.

Why the disconnect? To quote an often used phrase about the fire service, maybe this is “centuries of years of history unimpeded by progress…”  My point is that many of the reasons for using one can now be easily managed with more modern items such as clinging bandages and self-adhering tape.

Now, the triangular bandage has always been a useful tool. In fact, it is the utility player of the first aid kit with many applications. A “bandage” by common definition is something that holds a dressing in place against an injured body part. Because bandages are intended to control bleeding or stabilize an unstable body part, adequate pressure needs to be incorporated into their use. Injuries to the arms and legs are easily managed with wrapping-type bandages, but they do not work as well in areas such as the scalp, shoulder, or hip. Triangular bandages, however, have the unique ability to pressure wrap nearly any part of the human anatomy. In fact, there have literally been textbooks written on all of the specific bandaging techniques. There-in lies part of the problem. First-aid training today attempts to simplify things in order to gain confidence and effectiveness. It also focuses more on immediate threats such as performing CPR for sudden cardiac arrest. No time for the niceties of bandaging prior to the arrival of EMS. Triangular bandages are just one of those things that are having a hard time bridging the gap from old to new.

800px-Mathias_Mayor
Mathias Mayor –
Image courtesy of Wikipedia

Maybe we should start at the beginning to see how we got here. Let’s head back to Lausanne, Switzerland in the year 1830 (or thereabout), the home of surgeon Mathias Mayor. Even though simple bandaging had been done for many years, it was Mayor who was first credited with defining an organized method in which a simple handkerchief could be used in a variety of configurations to help manage common injuries in the short-term, until the injured person could be seen by a doctor. The triangular bandage actually began life as a square or rectangle. Mayor simply recommended a first step of folding the handkerchief corner to corner to produce the more functional triangular shape. Other commonly detailed shapes included the oblong, cravat, and cord, depending on the intended use. If Mayor were alive today, I would imagine him having his own late-night infomercial, hawking the unlimited benefits of the simple cloth square (and including a second one free with just shipping and handling charges).

As an interesting side-note, Mayor developed a specific use for a pair of the bandages called the “mayor’s Scarf”, a sling device intended to immobilize a fracture of the collarbone (also known today as a sling and swathe). A more modern day version of that device that is closely connected to the Mayo Clinic brings up the distinct possibility of a relationship between the names Mayor and Mayo.

800px-Friedrich_von_Esmarch

Johann Friedrich August von Esmarch –
Image courtesy of Wikipedia 

Time now to head to Germany in 1871 where surgeon Johann Friedrich August von Esmarch was the army’s Surgeon General. Having been a field surgeon in the Franco-Prussian War, Esmarch was keenly aware of the difficulties in stabilizing battlefield wounds to give wounded soldiers a chance to stay alive long enough to get more definitive care.

As part of a soldier’s standard gear, Esmarch created what was known as the “von Esmarch triangular cloth bandage”, an evolution of the bandage Mayor had created years earlier.

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EsmarchBandageOriginalLaterEdition

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 TOP :
The Original German Army Version of the Esmarch Bandage –
Image courtesy of The Royal Society of Medicine

CENTER:
Later German Army Version of the Esmarch Bandage –
Image courtesy of Wikipedia

BOTTOM:
Johnson & Johnson Version of the Esmarch Bandage

First, Esmarch simply pre-cut the bandage into the more functional triangular shape. Secondarily, he addressed the complication of how to use the bandage more effectively in multiple settings by literally printing illustrations of the common uses directly on the bandage itself. The initial illustrations were very realistic from a battle standpoint and there was a concern about them being too graphic. They were modified to be less graphic in future versions.

Esmarch was also known as a passionate advocate for the training of lay people in first aid techniques and spent much of the rest of his life dedicated to that cause as an author and lecturer. Many early first aid texts for lay providers in Europe and the United States can be traced back to Esmarch.

Esmarch’s illustrated bandage concept continued to live on. For example, in the early 1900’s Johnson & Johnson, the growing medical supply company that Robert Woods Johnson founded in New Brunswick, New Jersey, still printed illustrations of use directly on the bandages and maintained the “Esmarch” name on the packaging.

Today, the development of professional pre-hospital emergency medical services (EMS) has forever changed the fundamental role of the modern first-aider. The time gap between an injury and the availability of professional medical treatment is much shorter, down in most cases to minutes.  ntervention strategies that were once important to a first aid provider, such as bandaging a bleeding wound, are not as important as they once were. Using direct pressure on a dressing with a gloved hand is about all that is required until EMS arrives. As a result, there has been a slowly fading prominence of that historical first aid kit Swiss-army knife (Sorry, Dr. Mayor), the triangular bandage.

SEE ALSO: The History of Treating Sudden Cardiac Arrest

It’s always tough to see a long and trusted friend become less useful and increasingly ignored. It’s probably a bit too early to say its time has come, but, for now, the triangular bandage still remains steadfast and ready for use in whatever way you think it might be helpful. Maybe, if you get the chance, stop by your first aid kit, say hello to your triangular bandage, and let it know you were thinking about it today.

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