SURGERY. 



459 



refuse to yield to the means employed, poultices 

 should be applied, arid continued until all inflamma- 

 tory tendency has subsided; but the inflammation 

 induced seldom or never ends in suppuration, even 

 of the lips of the wound. When the incision heals, ! 

 and a hard tumour remains, absorption may be 

 promoted by rubbing the swelling night and morning ; 

 with the compound soap liniment. 



A much more dangerous accident sometimes ' 

 occurs from venesection, viz. the puncturing or i 

 wounding a tendon or a nerve. This happens almost i 

 entirely from mismanagement in the operator, and ' 

 is occasioned immediately by depressing the point of , 

 the lancet after it has been introduced into the cavity j 

 of the vein, and thus perforating both sides of the j 

 blood vessel. Nerves are, however, not so easily to j 

 be avoided as the tendons are, as being small and 

 scarcely to be distinguished, and in consequence of j 

 the twigs of the internal and external cutaneous 

 nerves, and even some of the spiral nerves entwin- j 

 ing the different veins. There is, however, scarcely 

 the shadow of an apology for wounding a tendon, [ 

 and the symptons are not less painful than those 

 produced by a wounded nerve. But, as we have 

 already stated, this can scarcely ever happen when 

 the lancet is properly introduced, and in almost 

 every case the blame may, without injustice, be laid 

 upon the operator. 



When a nerve is wounded, says professor Lizars, 

 the patient feels acute pain the moment the lancet 

 pierces the vein, and inflammation of the wound 

 follows, the nervous symptoms immediately com- 

 mence, and acute pains are experienced darting 

 along the arm to the neck and head, and even down 

 along the fingers; convulsive twitchings ensue, 

 accompanied with restless nights, being disturbed 

 by frightful dreams. When inflammation of the 

 wound does not take place it heals up, and some 

 days, even weeks, elapse before the convulsive 

 symptoms begin ; and in this case, which is the 

 more rare of the two, it resembles tetanus more 

 than the other. On some occasions, it assumes 

 the appearance of neuralgia. If the convulsive symp- 

 toms have been severe, in a few days spasms occur, 

 which dart from the head along the back, and bring 

 on trismus or lockjaw, which puts an end to the 

 patient's sufferings. 



Some respectable writers on surgery rather think 

 that in those cases where the severe symptoms do 

 not immediately follow the operation, or severe 

 pain felt at the time of introducing the lancet, are 

 rather cases of wounded tendon than of wounded 

 nerve ; and there are cases on record to bear them 

 out in this opinion ; but the symptoms of wounded 

 tendon is more properly considered under the 

 section wounded fascia. In both cases, however, 

 the best advice should be instantly procured. The 

 treatment in the first, noticed case, that is, where 

 the symptoms immediately follow the operation, 

 require to be very prompt and decided. The 

 wounded nerve must be divided close above or 

 proximate to the wound, the arm enveloped in an 

 opiate poultice, having half an ounce of opium dis- 

 solved in half a gallon of water, and if this should 

 not give relief to the patient, the actual cautery 

 should be applied to the wound.* The patient 



ought to be bled in the other arm or jugular vein 

 to a state of syncope or fainting, put in the warm 

 bath, have powerful cathartics given, followed by 

 large doses of opium or the preparations of Morphia, 

 and have tobacco clysters administered. The 

 bleeding to be repeated frequently, as circumstances 

 require ; and if all these remedies fail to subdue 

 the latent symptoms, a vein of the opposite arm 

 should be opened, and a solution of opium or of the 

 muriate of morphine injected into the circulating 

 system. It is a happy and merciful circumstance 

 that, seeing the operation of blood-letting is so 

 very frequently performed by ignorant and unedu- 

 cated persons, that this truly distressing accident 

 so very seldom occurs. In a pretty extensive ex- 

 perience of more than thirty years, we never met 

 with a single case. 



There is another distressing accident which 

 sometimes happens in blood-letting at the bend of 

 the arm, and that is wounding an artery. This, 

 however, never happens in the hands of a skilful 

 operator, and is generally, indeed we say always, 

 owing to the same cause as the pricking of a 

 tendon, viz. depressing the point of the lancet after 

 it enters the vein, and thus passing it through the 

 lower side, and wounding the artery, which lies im- 

 mediately below. The situation of the artery may 

 be always known by its pulsation, and if the finger 

 is applied to a vein below which an artery lies, it 

 will be felt. The artery is, however, situated so 

 deep that it cannot be wounded but by unpardon- 

 able carelessness, or using an ill-formed lancet. 

 Aneurism is the consequence of this accident, which 

 often requires an operation for its cure. 



From an over anxiety to heal the wound inflicted 

 in venesection, the bandage and compress are 

 taken off the next day, and adhesive plaster or 

 some other dressing applied ; but this, instead of 

 accelerating the union of the sides of the incision, 

 disturbs the adhesive process, and excites too great 

 a degree of inflammation. This inflammatory action, 

 which very speedily extends itself all over the arm, 

 confining itself to the skin, and assuming commonly 

 the erysipelatous character, or involves the sub- 

 jacent cellular tissue, or extends to the fascia of 

 the arm, or affects the lymphatics, or even the vein 

 itself. In addition to these causes of inflammation 

 of the vein, the lymphatics, and the fascia, these 

 may likewise be occasioned by a foul lancet, and of 

 this we have met with many examples. Lancets 

 employed in vaccination and opening venerial 

 buboes, or scrofulous and scorbutic abscesses, should 

 never be employed in phlebotomy till they have 

 been ground and thoroughly cleaned. There is 

 another cause of inflammation of the vein, and 

 which deserves to be noticed, as it is frequently 

 called into operation in the practice of domestic 

 surgery. When a second bleeding is required in 

 the course of twenty or twenty-four hours, a too 

 common practice is to abstract the second quantity 

 of blood from the same orifice, by applying another 

 ligature round the arm above the wound, till the 

 vein becomes swollen, then removing the first ban- 

 dage and the compress adhering to the wound, the 

 blood commonly springs out, but if not, the wound 

 is forcibly opened, either with the fingers, or by 



* The actual cautery is an iron heated to incandescence, and 

 the moxa. Tlie irons used for cauterizing are of various 

 shapes. The moxa is made of common cotton, immersed in a 

 solution of the nitrate of potass (*itltpetre\ of the strength of 

 five grains to an ounce of water, and afterwards dried. A 

 tmall quantity of this cotton is firmly rolled up, encircled with 

 a piece of card half an inch broad and three inches long, and 



afterwards tied round with thread. It is then fixed in a fort 

 feu, the one end set fire to, and the other held firmly on the 

 part to be chemosed. The common bellows are then om)ilnyi>d 

 to keep up the ignition of the cotton, which now resembles a 

 common fuse, luitil it is entirely consumed. The ignition 

 should be merely kept up, for the more slowly it burns the 

 more powerful is the .fleet. 



