PHLEBOTOMY 141 



by an assistant with the material to be injected, may now be appHed 

 to the needle, and pressure gently placed upon the piston of the 

 syringe by the operator's thumb, as in the case of inserting the 

 needle, but in the present case the pressure should be applied very 

 much more gradually. 



The needle should now be withdrawn, care being taken while so 

 doing to apply pressure to the skin near the seat of injection, to 

 prevent the escape of blood from the vein into the subcutaneous 

 tissue. 



Phlebotomy, Bleeding, or Blood-letting 

 This operation was very commonly practised a few years ago 

 in this country, but although it has lost favour with our modern 

 practitioners, it is still very frequently performed on the continent. 



The jugular vein is again usually the vessel selected, and there 

 are several methods of performing the operation. 



(l) A trocar and canula with a fine bore may be used after 

 the manner described in the previous operation of intravenous 

 injection, and blood thus extracted. 



(2) An incision may be made into the vein with an ordinary 

 scalpel or lancet, which should be held with about half an inch 

 of the blade exposed, between the thumb and forefinger of the 

 right hand. The vein should be raised after the manner already 

 described, when the exposed portion of the blade should be 

 pushed into the vessel, the scalpel being held at right angles to 

 the direction of the vein. 



(3) A third method, and perhaps the one most commonly 

 adopted, is phlebotomy by means of the ordinary fleam. In this 

 case the fleam should be held between the thumb and index 

 finger of the left hand, whilst the remaining fingers of the hand 

 are utilised to raise the vein by the application of pressure. 

 Having raised the vein and thus clearly made out its course, and 



