SURGERY. 205 



nerve dividing principally about the median vein ; '", aponeurotic strip, 

 which, proceeding from the tendon of the biceps, overlies the brachial 

 artery and vein, and median nerve, and passes into the radial side of the 

 fascia of the forearm ; ''- '•• '', circumference of the opening in the aponeu- 

 rosis, well defined internally, but externally confounded with the cellular 

 tissue; "''\ brachial artery; ", radial artery; ", ulnar artery; '", median 

 nerve; "•", brachial vein; " and "''", outer muscles, and '°''°, inner muscles 

 of the forearm; ", internal condyle of the elbow; ", a hook by which the 

 opening in the fascia is drawn inwards to show, above the tendinous strip 

 of the biceps, the brachial artery and vein, the median nerve, the brachiaeus 

 internus muscle, and the protractor teres ; ", everted skin with adipose 

 tissue; ■"', skin of the forearm; ", skin of the arm. 



In inflammation of deep-seated parts, especially such as threaten suppu- 

 ration, and even when this has already commenced, powerful counter- 

 irritants are frequently necessary and advisable ; these may consist in the 

 introduction of sctons, in the use of caustics, or the still more severe appli- 

 cation of the actual cautery with red hot iron, and of moxas. The irons 

 used in cauterization differ much in form. We shall here only mention the 

 prismatic cautery of Larrey (pi. 140, ßg. 38), whose prism has a narrow 

 base in proportion to its height, and has the anterior corners cut off oblique- 

 ly ; also the prismatic cautery of Kust (ßg. 39), which is 1 inch 4 lines long 

 and has three equal surfaces | of an inch in breadth. 



3. Acupuncture is an operation which has for a long time been success- 

 fully used in various ailments, as rheumatism, gout, &c. It consists in 

 repeatedly piercing the part affected with a long needle, moving it back- 

 wards and forwards in the wound. 



Sarlaridere's galvanic acupuncture needle {ßgs. 40, 41). 



2. Sewing up of Wounds, or Sutura Cruenta. 



Wounds are ol' various sorts: they are punctured, when produced by a 

 pointed instrument; incised, when made by a cutting instrument; lacerated, 

 when the parts are lacerated or torn ; poüoned, when some virulent sub- 

 stance has been introduced ; contused, when made by a blunt body, as a 

 bullet. Incised and punctured wounds are of most frequent occurrence, 

 and formerly were almost entirely treated by sewing up the edges ; more 

 modern surgery, however, rarely uses anything else than sticking-plaster 

 and proper bandages, by which the lips of the wound are more closely 

 approximated and the reparative powers of the system less interfered with. 

 The following sutures are those most employed at the present day, when at 

 all necessary. 



1. The Interrupted Suture, sutura nodosa (p^. 140, ßig. 28). This 

 requires as many ligature needles as there are ligatures, the needles 

 being of various shapes to suit the emergency {ßg. lb, the ligature needle 

 of Assolini ; ßg. 26, do. of Blasius; ßg. 27, do. of Savigny). Each needle 

 is to be provided with one or more turns of thread, as the ease may require. 



911 



