An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![after the first t^vo or three days, or if, after having once fallen, it again rises, and especially if a series of morning remissions and evening exacerbations show themselves, the evidences are unniistaka])le that inflammatory and sup- purative (listur])ances, with retention of secretion and septic al)sorption, are going on, and that a change of dressing with thorough exploration of the wound is required. When also the external hiyers of the dressings become moist with the secretions that have been imbibed from within, it is imperative that the dressings be renewed. This does not apply, however, to the frequent staining of the external layers of a dressing by the copious sero-bloody primary wound- secretion, which, when very hygroscopic materials are used, often occurs within a short time after the ap])lication of a dressing. In these cases the dressings quickly become and remain dry, and do not require to be changed. When drainage-tubes have been employed it is desirable that they be removed, in most cases, within a week or ten days, or often much earlier, for which purpose the dressing must be renewed. When for the purpose of controlling hemorrhage tampons have been left in sitii, these should be removed as early as the third day, and thus they would form another indication for a change of dressing. If the wound becomes the seat of suppuration or of sloughing, such fre- quency of dressings is required as may be needful to secure the adequate drainage and cleansing of the infected part. In general, changes of dressings should be made as rarely as possible, and only for the purpose of meeting dis- tinct indications. In changing dressings the same strict antisepsis should be observed as in the operation itself. Local Treatment.—While proper attention is being given to a wound the needs of the wounded part should not be overlooked. Nothing which could interfere in any Avay with its most perfect well-being should be con- sidered insignificant. The natural warmth of the part, perfect freedom of the circulation, tlie control of muscular spasm, and the most perfect quiet and comfort are all of importance to be secured. Position.—A position that will be comfortable to the patient should if pos- sible be selected. This will always be one in which the muscles are relaxed and the return circulation of the blood to the heart is fiivored. The relation of position to drainage should be kept in mind, and in the arranging of the means for drainage whenever possible the drains should be so placed as to be most efficient when the part shall have been placed in a position of the greatest comfort. Compression.—Gentle, uniform, and continuous pressure is of great value in promoting rapid repair after injury. It restrains excessive local hyperemia, limits effusion, and promotes absorption of effusions already present; h antag- onizes muscular spasm and contributes to rest of the ])art. A greater and more methodical application of pressure than is needful for maintaining simple apposition of the separated parts is required in order to obtain the full power of compression in favoring the repair of a wound. Comjn-ession should be smooth and uniform, gentle but firm, carefully avoiding any constriction. In most cases it may be best effected by covering the wounded part with layers of cotton wool and applying compression with bandages. The wool by its elas- ticity tends to distribute evenly the compression exercised by the bandage and to keep the pressure continuously uniform. Immobilization.—While the means of compression just described will in many instances be sufficient to give whatever extraneous aid is required to pre- vent motion in the wounded part, in many others there will be needed some further assistance in securing the desired immol)ility. For this purpose splints of various kinds are available. Whenever any form of plastic splint can be](https://iiif.wellcomecollection.org/image/b21217014_0140.jp2/full/800%2C/0/default.jpg)
