DRESSINGS. 97 



rules we iiave given. The completion of the process by the appli- 

 cation of the final dressings and proper finishing steps can scarce- 

 ly be subjected to rules which could not well be framed to meet the 

 varieties in the features and circumstances of the diversified cases 

 constantly occurring in practice. The only strictly general rule 

 that can be established, is, that when a bandage is placed on the 

 outside of a dressing, it must always, first of all, be fixed at the 

 points which are the most essential to secure it and maintain it in 

 its proper place. 



The proper time for the removal or change of a dressing, is a 

 question which depends for an answer upon the consideration of 

 the nature of the wound, the season of the year, the age and con- 

 dition of the j)atient ; in fact upon all the various circumstances 

 which in the judgment of the surgeon may influence the progress 

 of the cicatrization. 



On general principles, the first di-essing is not to be removed 

 until the sujopurative process is thoroughly established, which is 

 towards the fourth or fifth day. But there are cases where special 

 circumstances indicate an earUer or a later removal. For examjDle, 

 if the dressing has been applied to control the hemorrhage of a 

 divided blood vessel, from twenty-four to thirty-six houi'S are 

 generally sufficient to obtain the obHteration of the vessel. 

 Again, while it is justifiable to leave the dressing of a foot, which 

 has been subjected to an operation, for eight, fifteen, twenty, and 

 even twenty-five days without changing, and especially in these 

 days of antiseptics when so much is possible in the way of com- 

 bating the suppurative process, there are no doubt cases where 

 it must be looked after earher, as where there is an exhibition of 

 increased pain, instead of the abatement which might be justifi- 

 ably looked for if the operation and the dressing had been 

 properly executed; the increase of pain indicating some compli- 

 cations which early exposure might easily have controlled. There 

 are, however, conditions where the removal of a dressing is in- 

 dicated in some more than in others, as, for instance, when sup- 

 puration is abundant. In these cases, to prevent the retention of 

 the pus in the wounds, and to diminish the danger of its pres- 

 ence, or of its absorption, or facilitate its escape, di-ainage tubes 

 must be used, or the dressing changed. 



The removal of a first dressing usually involves an attention 

 to minute details not subsequently required, the various parts 



