18 SURGERY. 



paleness of the lips, sighing, nausea, fluttering of the pulse, or 

 relief of pain. The ability to bear bleeding will vary according to 

 age, sex, temperament, and disease. A man in health will faint 

 usually from the loss of fifteen ounces ; the same person, with a 

 severe inflammation, particularly of the head, will bear double that 

 amount. Reaction takes place after bleeding, the pulse rises, and 

 pain increases, often to such an extent, as to require a second amount 

 to be taken. A smaller quantity will now produce the same eftects 

 as a large one in the first instance. The operation is usually per- 

 formed at the bend of the arm, in the neck, or in the anterior tem- 

 poral artery. 



Local Bleeding. — This is preferable when the inflammatory action 

 is not high ; when the powers of the system are low, when the 

 inflammatory action on the part has been fully established, and there 

 would be no benefit from a general bleeding, and when extreme age 

 forbids it. 



Cupinng. — By this means blood is obtained more rapidly than 

 by leeches, and we have the advantage of general bleeding combined 

 with local abstraction. 



Leeching. — Leeches can be applied where cups cannot. In order 

 to apply them, the part should be first washed, and if they will not 

 stick, a little cream or blood should be smeared on it. Their 

 appetite is increased by being dry. If slow to bite, immersion in 

 warm porter will be useful. Their bites are sometimes troublesome 

 from hsemorrhage. This is arrested by the mur. tinct. ferri, or a 

 fine point of nitrate of silver. American leeches will draw a 3 or 

 3iss. of blood ; foreign leeches take an 5 or 3iss. Salt will occasion 

 them to drop off. 



Purgatives. — They deplete, by causing an increase of mucous 

 exhalation from the bowels. They also act as derivant, prevent 

 assimilation of nutrition, and promote absorption ; they are particu- 

 larly useful in diseases of the head, but are contra-indicated in bad 

 fractures, and inflammatory affections of the bowels. 



Emetics, diaphoretics, and diuretics are useful at the outset, 

 emptying the stomach, and promoting perspiration, particularly the 

 tart. ant. et potass?e. 



Mercury. — Not only as a purge, but gradually introduced into the 

 system, it seems to exert a tonic effect on both the extreme blood- 

 vessels and the lymphatics ; that is, in the exhalents and absorbents, 

 thus preventing or limiting impending effusion, and at the same time 

 expediting the removal of that which had already been exuded. 



Opium. — Particularly useful when combined with calomel, and 

 given after bleeding. Before bleeding it arrests secretion, and stimu- 

 lates, — afterwards, it soothes the nervous system, relieves pain, and 

 prevents reaction. 



A strict diet must be maintained, and the drink should be refri- 



