DRESSINGS. 91 



of the surgeon, and the indications of the case. Such is a fair, 

 though brief synopsis of the duties of the niu'se, upon whom it 

 devolves to give effect to the rules of surgical therafpeutlcs. 



A well-ai:)pLied di-essing may become the first stej) toward 

 assuring the success of an operation, those following it — even 

 when only methodically executed — being mere continuous degrees 

 of the one well begun action. A well-apphed dressing may sup- 

 ply the defects and amend the errors of an improperly performed 

 operation; and, on the other hand, a bad dressing may jeopardize 

 the success of a well-executed operation by interfering with the 

 process of cicatrization, and in other ways delay the recovery of 

 the patient, and even prevent it entirely, by causing unfavorable 

 complications. 



The application of all dressings is subject to certain general 

 rules, from which no deviation is allowable. As in every action in 

 life, the first step should be that of preparing all the necessary 

 means and apphances for the work, and the last, before beginning 

 the actual manipulation, should be to ascertain that nothing more 

 remains to be provided, at the risk of a serious interruption and 

 delay, and loss of time in a search for some missing article of 

 necessity. On such a point the merest hint should be sufficient, 

 and, indeed, even a hint should be unnecessary with a practical 

 and thoughtful person; but, unfortunately, all persons are not 

 practical and thoughtful. 



The next step for the surgeon is to secure for himself and his 

 patient a favorable arrangement in resj^ect to hght and room. 

 There must be nothing interposed before the eye, or that can limit 

 the free movement of the hand and the arm — a most obvious sug- 

 gestion. 



Before applying a dressing, the wound should be thoroughly 

 cleansed and freed from blood, pus, the remains of previous 

 dressings, and, in a word, of any foreign or other substances 

 capable of becoming sources of irritation. This is best done 

 with water alone, but its effect is frequently greatly improved by 

 combining with it some of the compounds, such as carbolic acid, 

 sanitas, creoline, etc., which have proved their value as antiseptic 

 agents. It may be applied by carefully passing a fine sj)onge or 

 a ball of oakum over the siu'face of the wound, or it may be used 

 more freely in larger ablutions. Crusts or scabs, if any, may be 

 removed with the scissors or scraped away with the spatula, but 



