45* 



SURGERY. 



letting, especially in parts situated in such a manner 

 that the scarificator cannot be applied. Sometimes 

 it in difficult to make them fix upon the particular 

 spot we wish, but they may be induced to do so by 

 washing the part well with tepid water without 

 soap, drying it well, and then marking the spots 

 where we wish them to fasten with cream or 

 sweet milk, or making a small puncture with a 

 lancet, and then confining the leeches over the part 

 with :i wine glass. Leeches will fasten more readily 

 if allowed to crawl about for a few minutes on a 

 soft dry towel before they are applied. After they 

 have fallen off, the most common method is to 

 bathe the parts in warm water to promote the 

 bleeding ; but where a cupping glass can be applied, 

 it will generally be found preferable. 



Uses and effects of Blood-letting. Blood-letting 

 has been in use from time immemorial ; but the 

 indiscriminate use of it in all disorders has un- 

 doubtedly been productive of much mischief, as, on 

 the other hand, in a great number of cases, it is 

 undoubtedly attended with much benefit. As this 

 operation empties the vessels, it hence follows that 

 it ought never to be performed but where the 

 quantity of fluids is too great, either with respect 

 to the system in general, or to some particular part 

 already affected by disease. In those diseases called 

 inflammatory, especially fever, where the action 

 of the heart and arteries is greatly increased, the 

 blood circulates rapidly through the whole body, 

 and the general disorder is augmented by the cir- 

 cumstances of quantity ; and the taking away a part 

 of it, by giving the vessels more freedom to play 

 properly, contributes very much towards the cure. 

 In the case, too, of strangulated hernia or rupture, 

 where a portion of the intestines descends through 

 the external coverings of the abdomen, and gets so 

 compressed or locked in the passage through which 

 it passed, that it refuses to return ; through this 

 pressure, the intestines are greatly inflamed; al- 

 though the quantity of blood may not be too great 

 with regard to the whole system, yet it is too great 

 for the parts in that situation to bear. The ab- 

 straction of a quantity of blood, by lessening the 

 pressure upon that particular part, diminishes the 

 disease, and if a large quantity is quickly taken 

 away from a large incision, so that the patient 

 faints, the general contraction which takes place 

 all over the system, and of course on the parts 

 affected, enables the surgeon to reduce the hernia, 

 or in other words, return the portion of the intes- 

 tine, and thus save the life of the patient. 



In all cases of inflammation the advantages of 

 blood-letting must be very apparent ; and especially 

 the effects of general blood-letting, by lessening 

 the pressure of the blood upon any particular 

 diseased part, undoubtedly diminishes the inflam- 

 matory affection. In these cases, topical, as well 

 as general blood-letting, must be of considerable 

 use ; for as the latter diminishes the impulse of the 

 circulating blood upon the inflamed part, the former 

 diminishes the quantity of blood in the part itself; 

 and, indeed, in those cases where inflammation is 

 not attended with much fever, topical bleeding is 

 found to be more efficacious than the other. Dry 

 cupping, as we have already stated, seems calcu- 

 lated to promote the circulation through any par- 

 ticular part, by soliciting the blood and other fluids 

 thither. On the contrary, as blood-letting is ol 

 very considerable advantage in those disorders 

 called inflammatory, whether arising from disease 

 or external injury, it must of course be equally prc- 



udicial where the fluids do not bear a proportion to 

 the strength of the vessels so as to distend them 

 sufficiently. It ought not, therefore, to be practised 

 in low nervous fevers, intermittents, hysterical 

 affections, or nervous disorders of any kind, except, 

 it may be, in cases of furious mania, where the 

 nervous system is affected. 



The custom of young people in good health, 

 .osing a quantity of blood in the spring, as they 

 say, to render them light and cheerful during the 

 summer, and to make way for a supply of fresher 

 and purer blood, ought certainly to be denounced 

 as highly injurious to the constitution. It becomes 

 a regular habit, and the person feels uneasy till the 

 usual quantity is taken away. This is, in plain 

 language, comparing the human frame to a haber- 

 dasher's shop, and subjecting the former to the 

 laws and regulations of the latter, viz. expelling 

 the unsuitable part of the remaining winter stork, 

 to make room for the summer supplies. See Dr 

 Andrew's Letter on this subject. 



Accidents, or affections consequent on Blood-letting. 

 Every surgeon should be well informed with respect 

 to those accidents or disorders most likely to at- 

 tend or supervene on a surgical operation, and 

 more especially those who, without a regular pro- 

 fessional education, occasionally perform the opera- 

 tion of blood-letting. The most common accident 

 attendant on this operation is thrombus, or ecchy- 

 tnosis, which is a small tumor around the orifice, 

 occasioned by the blood insinuating itself into the 

 cellular membrane, between the skin and muscular 

 flesh, and occasioned principally by the shifting of the 

 fekin over the vein during the time that the blood 

 flows out of it. All surgical operations are fol- 

 lowed by more or less ecchymosis, according as the 

 parts have been torn or bruised during the opera- 

 tion; but it even supervenes in a slight degree 

 in operations most scientifically performed, espe- 

 cially in the face and other delicate parts of the 

 body, as the knife cuts on the principles of a saw. 

 In blood-letting, however, there is even a possibility 

 of removing the tumour during the time of the 

 operation, by untying the ligature, and bringing the 

 member into exactly the same position in which it 

 was before the vein was opened. On applying the 

 ligature a second time, the blood will frequently 

 flow as freely as before, and while it flows the 

 tumour will frequently subside, or at kast not 

 arrive at such a size as to obstruct the efflux of the 

 blood. Sometimes, however, it arrives to such a 

 height as entirely to obstruct the operation, and 

 prevent it from being finished. When this is the 

 case, the most effectual method of preventing the 

 tumour from being increased still further is by re- 

 moving the bandage, for by continuing the bandage 

 a very considerable swelling may be induced, and 

 such as might be attended with great trouble ; and 

 if more blood requires to be taken away, it must 

 be taken from another vein. Tumours oi this kind 

 (for there is a little distinction between a thrornbuh 

 and ecchymosis,Hhe former being a circumscribed 

 tumour, and the other a diffused effusion of blood) 

 seldom require any application ; both, however, re- 

 quire the same treatment, and unless the quantity of 

 blood be profuse, in either the effusion is of little con- 

 sequence. When remedies are required, astringents 

 or stimulating embrocations are to be preferred, com- 

 presses moistened with brandy, rum, or whiskey, or, 

 what is more economical, a solution of lead, and kept 

 on by a loose bandage. If, however, the effusion be 

 extensive, and produce pain and inflammation, and 



