456 



SURGERY. 



be overcome by tbe steadiness of the operator ; and 

 by stroking up tin; vein with the ligature before 

 he ties it on, the rolling will be prevented. The 

 operator then puts the thumb of his left hand upon 

 the vein about an inch and a half below the place 

 where he intends to make the orifice; but if the 

 vein rolls much, the distance must be less, even to 

 ha.f an indi. He then takes the lancet, bent to a 

 somewhat acute angle, between the thumb and fore 

 linger of the right hand, leaving one half of the 

 blade uncovered; and resting the hand upon the 

 other three fingers, he is to enter the lancet in an 

 oblique direction, as in the figure, pushing the point 

 through the skin, cellular substance, and vein, till 

 the blood appears on each side of the lancet. Then 

 raising up the point in as straight a line as possible, 

 he makes the wound in the skin and vein quite 

 equal, as they ought to be. The thumb is with- 

 dnuvn to allow the blood to run freely, and the 

 arm should be kept in the same position while the 

 blood flows. It is sometimes of* service to grasp 

 a round substance in the hand, a custom now, how- 

 ever, nearly out of fashion. If the position of the 

 arm is shitted, the skin will be apt to slip over 

 the orifice in the vein, and greatly impede, if not 

 altogether stop, the flow of blood, which would 

 insinuate itself below the arm and among the cel- 

 lular substance, and prove a great inconvenience. 

 When the required quantity of blood has been ab- 

 stracted, the ligature should be immediately untied, 

 which is easily done, being always tied with a 

 single slip knot. The compresses, formed as already 

 described, should be now applied, first bringing the 

 edges of the wound accurately together, and the 

 compresses secured by the ligature, or other ban- 

 dage, put round the arm, crossing immediately 

 above the compress in the form of the figure 8, as 

 shown in the plate. (See Plate LXXXVI, fig. 3.) 

 Sometimes, however, the blood will continue to 

 flow with great rapidity after the ligature has 

 been removed and the compresses applied, espe- 

 cially where the orifice is large and the circulation 

 very vigorous. The vein in this case must be com- 

 pressed both above and below the orifice with the 

 fore and middle finger of the operator's left hand, 

 the arm washed clean from the blood, and the sides 

 of the orifice laid close together ; any blood which 

 may remain in the wound to be pressed out by 

 working the vein a little between the fore fingers 

 of both hands, and a fresh and larger compress 

 applied and firmly kept down by the bandage 

 applied, in the same form as already directed. 

 Where a sharp, clean lancet has been employed, 

 and these directions attended to, the wound will 

 heal readily by the first intention, that is, by the 

 adhesion of the parts to each other without any 

 suppuration. 



Phlebotomy, another technical term for blood- 

 letting, is performed in the feet, in the same manner 

 as in the other parts; but the blood runs more 

 slowly than from the arm, and it has therefore been 

 customary to immerse the feet and ankles in warm 

 water after performing the operation. The ligature 

 is to be applied a little above the ancle joint, (see 

 Plate LXXXVI, fig. 8), in consequence of which 

 the veins both on the inside and outside will appeal- 

 very conspicuous, being covered only with skin, 

 and pressed by the ligature against the bones. 

 Indeed, where we intend to let blood, the ligature 

 is to be applied to that part where the veins are 

 most exposed and can be most easily compressed 

 against the bones or subjacent parts. The opera- 



tion of blood-letting at the ancle or on the foot is 



not so frequently employed as formerly ; but we 



! have pointed out, on the figure referred to, the 



places where an incision may be made, and it may be 



made iu any conspicuous vein. In these veins the 



rirculation is generally so weak as only to require 



' the application of a slip of adhesive plaster to 



j the wound, after bringing the edges accurately 



together. 



The operation of blood-letting is occasionally 

 performed at the wrist, or on the back of the 

 hand, when there is a difficulty of obtaining blood 

 at the bend of the arm, by the veins being so 

 deeply situated, and the patient of a full plethoric 

 habit. In this case, the ligature may be applied 

 about an inch above the wrist, and if the veins are 

 not distinctly seen, the hand may be dipped in 

 warm water ; the most prominent vein should be 

 opened, and the operation performed in other 

 respects as at the elbow joint. 



When a vein in the scrotum is opened, it is 

 requisite that the patient stand upright, and the 

 part be immersed in warm water. Blood-letting 

 below the tongue is seldom employed, and opera- 

 tions in such places, when required, should always 

 be intrusted to professional men. 



Blood is frequently drawn from the temporal 

 artery, and sometimes, but rarely, from other arteries, 

 and the operation for this purpose is called Arterio- 

 tomy. Arterial blood being of a very different 

 nature from venous blood, it has been supposed 

 the abstraction of blood from an artery is more 

 efficacious than the same quantity from a vein. 

 The stream of blood from an artery is, however, 

 so impetuous, that the branches of the temporal 

 artery, which lie so near to the temporal and 

 parietal bones (see Plate LXXXVI, fig. 4), that 

 they can be easily compressed against, are almost 

 always preferred, as the flux of blood may be 

 stopped without much difficulty. If the temporal 

 artery, or any of its branches, lies near the surface, 

 the opening may be made at once with a lancet, 

 as in venesection, or opening a vein ; but in many 

 cases it lies so low, that it becomes necessary, in 

 the first place, to cut the skin and integuments, 

 and lay the vessel quite open, as directed in opening 

 the jugular vein, and then making an incision in 

 the artery, as if it were a vein, somewhat obliquely, 

 or a little across the vessel ; for if it is made quite 

 in the direction of the longitudinal fibres, the sides 

 of the wound collapse, and the blood cannot flow 

 out ; or, to be more particular, let the patient be 

 placed in a horizontal position, with his head resting 

 on a pillow, the operator, feeling the course of the 

 trunk of the artery, or one of its branches, as it 

 ascends along the temples, places the fore and middle 

 fingers of his left hand on the vessel, in order to 

 render it steady, the one above and the other below 

 the spot where the incision is to be made ; and then 

 he is to cut down through the skin and integuments, 

 and open the vessel as above described. 



The blood generally flows with sufficient freedom 

 from a wounded artery without any compression ; 

 but should this happen not to be the case, the com- 

 pression should be made above the orifice, so that 

 it may interrupt the blood flowing out from the 

 heart, and thus augment the flux through the ori- 

 fice. The required quantity of blood being ob- 

 tained, the edges of the wound are to be accurately 

 approximated or brought together, a firm compress 

 applied, and a roller or bandage of calico wound 

 over the compress, encircling the head, and cross- 



