hard cast material but has difficulty cutting soft material like cast padding or skin. although the removal is often painless, this can be distressing for the patient, especially children. a cast saw can cut, abrade, or burn skin, but those results are uncommon. additionally, plaster of paris casts break down if patients get them wet. due to the limitations of plaster of paris, surgeons have also experimented with other types of materials for use as splints. an early plastic like material was gutta-percha obtained from the latex of trees found in malaya. it resembled rubber, but contained more resins. when dry it was hard and inelastic, but when warmed it became soft and malleable. in 1851 utterhoeven described the use of splints made from this material for the treatment of fractures. in the 1970s, the development of fibreglass casting tape made it possible to produce a cast that was lighter and more durable than the traditional plaster cast and also resistant to water (though the bandages underneath were not) helping the patient be more active. in the 1990s the introduction of new cast lining has meant that fiberglass casts with this liner are completely waterproof, allowing patients to bathe, shower, and swim while wearing a cast. the waterproof cast liner however adds approximately 2 to 3 more minutes to the application time of the cast and increases the cost of the cast. drying time, however, can be inconvenient enough to warrant a cast and bandage moisture protector. these waterproof covers allow for bathing and showering while wearing either a plaster or fiberglass cast. the waterproof cast cover stays tightly around the cast and prevents water from ever reaching it while the patient is in contact with water. the cover can easily be removed to dry, and can be re-used often. cast liner cast liners are often cotton, though waterproof lining material is also available. flexioh orthopedic cast for foot and ankle fracture washable casts there are some washable casts like flexioh which provide good ventilation and maintain good skin hygiene. with this cast, patients are able to bathe and go out in the rain. these type of cast has advantages that deliver patient a better treatment than conventional cast like plaster of paris or fiberglass. they are the next generation orthopedic immobilization photo-curing specialty-resin technology that enables waterproof, washable, lightweight, strong and comfortable way of recovering from fractures. removal main article: cast saw an orange short arm cast with a fiberglass top layer being cut and removed with a specialized cast saw. casts are typically removed by perforation using a cast saw, an oscillating saw designed to cut rigid material such as plaster or fiberglass while not harming soft tissue. manually operated shears, patented in 1950 by neil mckay, may be used on pediatric or other patients who may be affected by the noise of the saw. history hippocrates: a conventionalized image in a roman "portrait" bust (19th-century engraving)the earliest methods of holding a reduced fracture involved using splints. these are rigid strips laid parallel to each other alongside the bone. the ancient egyptians used wooden splints made of bark wrapped in linen. they also used stiff bandages for support that were probably derived from embalming techniques. the use of plaster of paris to cover walls is evident, but it seems it was never used for bandages. ancient hindus treated fractures with bamboo splints, and the writings of hippocrates discuss management of fractures in some detail, recommending wooden splints plus exercise to prevent muscle atrophy during the immobilization. the ancient greeks also used waxes and resins to create stiffened bandages and the roman celsus, writing in ad 30, describes how to use splints and bandages stiffened with starch. arabian doctors used lime derived from sea shells and albumen from egg whites to stiffen bandages. the italian school of salerno in the twelfth century recommended bandages hardened with a flour and egg mixture as did medieval european bonesetters, who used casts made of egg white, flour, and animal fat. by the sixteenth century the famous french surgeon ambroise paré (1517–1590), who championed more humane treatments in medicine and promoted the use of artificial limbs, made casts of wax, cardboard, cloth, and parchment that hardened as they dried. these methods all had merit, but the standard method for the healing of fractures was bed rest and restriction of activity. the search for a simpler, less-time-consuming, method led to the development of the first modern occlusive dressings, stiffened at first with starch and later with plaster-of-paris. the ambulatory treatment of fractures was the direct result of these innovations. the innovation of the modern cast can be traced to, among others, four military surgeons, dominique jean larrey, louis seutin, antonius mathijsen, and nikolai ivanovich pirogov. dominique jean larrey (1768–1842) was born in a small town in southern france. he first studied medicine with his uncle, a surgeon in toulouse. after a short tour of duty as a naval surgeon, he returned to paris, where he became caught up in the turmoil of the revolution, being present at the storming of the bastille. from then on, he made his career as a surgeon in france's revolutionary and napoleonic armies, which he accompanied throughout europe and the middle east. as a result, larrey accumulated a vast experience of military medicine and surgery. one of his patients after the battle of borodino in 1812 was an infantry officer whose arm was amputated at the shoulder. the patient was evacuated immediately following the operation and passed from russia, through poland and germany. when the dressing was removed on his arrival home in france, the wound had healed. larrey concluded that the fact that the wound had been undisturbed had facilitated healing. after the war, larrey began stiffening bandages using camphorated alcohol, lead acetate and egg whites beaten in water. an improved method was introduced by louis seutin, (1793–1865) of brussels. in 1815 seutin had served in the allied armies in the war against napoleon and was on the field of waterloo. at the time of the development of his bandage he was chief surgeon in the belgium army. seutin's "bandage amidonnee" consisted of cardboard splints and bandages soaked in a solution of starch and applied wet. these dressings required 2 to 3 days to dry, depending on the temperature and humidity of the surroundings. the substitution of dextrin for starch, advocated by velpeau, the man widely regarded as the leading french surgeon at the beginning of the 19th century, reduced the drying time to 6 hours. although this was a vast improvement, it was still a long time, especially in the harsh environment of the battlefield. a good description of seutin's technique was provided by sampson gamgee who learned it from seutin in france during the winter of 1851–52 and went on to promote its use in britain. the limb was initially wrapped in wool, especially over any bony prominences. pasteboard was then cut into shape to provide a splint, and dampened so it could be molded to the limb. the limb was then wrapped in bandages before a starch coating was applied to the outer surface. seutin's technique for the application of the starch apparatus formed the basis of the technique used with plaster of paris dressings today. the use of this method led to the early mobilization of patients with fractures and a marked reduction in hospital time required. plaster casts gypsum from new south wales, australiaalthough these bandages were an improvement over larrey's method, they were far from ideal. they required a long time to apply and dry and there was often shrinkage and distortion. a great deal of interest had been aroused in europe around 1800 by a british diplomat, consul william eton, who described a method of treating fractures that he had observed in turkey. he noted that gypsum plaster (plaster of paris) was moulded around the patient's leg to cause immobilization. if the cast became loose due to atrophy or a reduction in swelling, then additional gypsum plaster was added to fill the space. adapting the use of plaster of paris for use in hospitals, however, took some time. in 1828, doctors in berlin were treating leg fractures by aligning the bones in a long narrow box, which they filled with moist sand. substitution of plaster of paris for the sand was the next logical step. such plaster casts did not succeed however as the patient was confined to bed due to the casts being heavy and cumbersome. a box of plaster of paris bandages, c. 1960 plaster of paris bandages were introduced in different forms by two army surgeons, one at a peacetime home station and another on active service at the front. antonius mathijsen (1805–1878) was born in budel, the netherlands, where his father was the village doctor. he was educated in brussels, maastricht and utrecht obtaining the degree of doctor of medicine at gissen in 1837. he spent his entire career as a medical officer in the dutch army. while he was stationed at haarlem in 1851, he developed a method of applying plaster of paris bandages. a brief note describing his method was published on january 30, 1852; it was followed shortly by more complete accounts. in these accounts mathijsen emphasised that only simple materials were required and the bandage could be quickly applied without assistance. the bandages hardened rapidly, provided an exact fit and could be windowed or bivalved (cut to provide strain relief) easily. mathijsen used coarsely woven materials, usually linen, into which dry plaster of paris had been rubbed thoroughly. the bandages were then moistened with a wet sponge or brush as they were applied and rubbed by hand until they hardened. plaster of paris dressings were first employed in the treatment of mass casualties in the 1850s during the crimean war by nikolai ivanovich pirogov (1810–1881). pirogov was born in moscow and received his early education there. after obtaining a medical degree at dorpat (now tartu, estonia) he studied at berlin and göttingen before returning to dorpat as a professor of surgery. in 1840, he became the professor of surgery at the academy of military medicine in st. petersburg. pirogov introduced the use of ether anaesthesia to russia and made important contributions to the study of cross-sectional human anatomy. with the help of his patron, the grand duchess helene pavlovna, he introduced female nurses into the military hospitals at the same time that florence nightingale was beginning a similar program in british military hospitals. a plaster-impregnated bandage c. 2005, still in its packaging. seutin had travelled through russia demonstrating his 'starched bandage', and his technique had been adopted by both the russian army and navy by 1837. pirogov had observed the use of plaster of paris bandages in the studio of a sculptor who used strips of linen soaked in liquid plaster of paris for making models (this technique, called "modroc," is still popular). pirogov went on to develop his own methods, although he was aware of mathijsen's work. pirogov's method involved soaking coarse cloth in a plaster of paris mixture immediately before application to the limbs, which were protected either by stockings or cotton pads. large dressings were reinforced with pieces of wood. as time passed and the method moved more into the mainstream some disagreement arose as to the problems associated with cutting off air to skin contact, and also some improvements were made. eventually pirogov's method gave way to mathijsen's. among the improvements suggested as early as 1860 was that of making the dressing resistant to water by painting the dried plaster of paris with a mixture of shellac dissolved in alcohol. the first commercial bandages were not produced until 1931 in germany, and were called cellona. before that the bandages were made by hand at the hospitals. as a plaster cast is applied, it expands by approximately 0.5%. the less water used, the more linear expansion occurs. potassium sulfate can be used as an accelerator and sodium borate as a retarder to control setting time.