92 OPERATIVE TECHXIOUE. 



then rinsed with boiled salt water. The surgeon, after having 

 thoroughly cleansed his nails, washes his hands and forearms in 

 the salt solution. A basin in which a little alcohol has been ignited 

 is filled 'vith boiled water for the purpose of cleansing the hands 

 during operation. The instruments can be disinfected by passing 

 them through the flame of an alcohol lamp, or by moistening them 

 wath alcohol which is afterwards ignited, or even by immersing 

 them for five m- ten minutes in a boiling i per cent, solution of 

 carbonate of soda, /. c. ordinary' washing soda. To disinfect cloths, 

 tampons for cleansing the wound, suture material, and tow, boiling 

 salt solution can be used. 



The seat of operation is protected by a "dressing" formed of 

 layers of surgical wadding or tow. suitabl}- arranged and fixed in 

 position by bandages [see Chapter on " Bandaging and Dressing")- 

 Dressings applied to the upper regions of a limb should either 

 be comparative!}' loose or should extend to all the parts below, 

 in order to a\oid interference wiih circulation rtnd such consequences 

 as swelling and sloughing. 



The first dressing is exceedingl}- important. \'er)- often it 

 deteriTiines the entire after-course of the wound. It can be left in 

 place for a var3dng time. If the patient's general condition is 

 good, and the fever is sHght, and if the dressing remains dry, 

 it need not he renewed for t\\el\e to fifteen da}S in winter, and 

 from eight to ten da}-s in summer, if. during removal, the deep 

 la}'ers of wadding adhere to the skin, tlie\- should be moistened 

 and softened with a warm antiseptic solution, or in the case of 

 the foot by placing the extremity in a bucket containing the liquid. 

 The skin should be carefulh' cleansed with tampons of cotton wool. 



Where primary union has occurred the wound is found cicatrised 

 on removal of the first dressing ; if, however, it is only progressing 

 favourabl}', nothing more is needed than the application of a fresh 

 dressing, the same precautions being observed as on the first occasion. 

 Care must be taken to avoid disturbing the wound or moving the lips ; 

 drainage-tubes can be replaced after disinfection, fresh ones of similar 

 calibre but of shorter length can be substituted, or drain, ige-tubes may 

 altogether be discontinued. When the wound is suppiuati ng the 

 s tures must he cut, the drainage-tubes removed, and the whole cavit}' 

 freely washed out, avoiding injury to granulating surfaces. A new 

 dressing, wit . or without drainage, may be applied, or the wound may 

 be left open and treated with antiseptic liquids or powders. The latter 

 absorb wound discharges, check the growth of germs on the surface, 

 and diminish the absorption of toxic products. 



