650 OPEEATIONS. 



As the branches of the carotid artery lie close under those of 

 the jugular vein, it is saier to use a fleam than a lancet for 

 bleeding, unless a guarded lancet, made for the purpose be 

 employed. 



The near side is the more convenient one of the two, for a right- 

 handed man, on which to bleed with the fleam. As blemishes, 

 however, are less likely to be noticed on the off than on the near 

 side, the former may be selected in the case of a valuable animal. 

 The cutting portion of the fleam should be broad, so as to obtain 

 rapid depletion, which produces a much better effect than when 

 the operation is prolonged ; the amount abstracted being the same 

 in both cases. The blade should be clean, sharp, and smooth, so 

 as not to injure the vein unnecessarily. 



The spot having been selected, the skin immediately above it 

 should be smoothed down with a damp sponge. 



The operator should open the fleam so that its back should be 

 at a little more than a right angle with the handle. He should 

 hold the joint of the instrument with the tips of the index finger 

 and thumb of his left hand, and allow the handle to rest on the 

 space between the finger and thumb. If there be a second assistant, 

 he should press the vein, in order to make it more clearly defined ; 

 but if there be no one to help, the operator should, by pressing 

 his fingers on the vein, assure himself of its exact position. Having 

 ascertained this, he should place the cutting edge of the fleam in 

 the centre and along the course of the vein, but not across it ; for 

 a. longitudinal incision will give a more copious flow of blood than 

 a transverse one, which might destroy the continuity of the vein. 

 He should then take the blood-stick (which is purposely made short 

 and heavy) in his right hand, and strike the back of the fleam a 

 sharp measured blow with it, at a point just above the cutting 

 edge. On removing the fleam, a jet. of blood will flow out, if the 

 operation has been properly done. If, however, the flow of blood 

 be slight or altogether wanting, the non-success may be due, either 

 to the vein not having been punctured, or to the opening in the 

 skin not corresponding to that made in the vein, owing to the 

 position of the head having been shifted. The operator may satisfy 

 himself on the first point, by compressing the vein a little below 

 the incision; and, on the second point, by bringing the head back 

 to the position it occupied when the fleam was 'struck. If the 

 blow has been too light, although the fleam might have been held 

 correctly, a second incision may be made at the same spot, or a 

 little above or below it. It is the safer plan, however, to make 

 a second attempt on the other side. 



When an opening is to be made in the right vein, the operator, 

 before striking, may cause it to become distended by pressing it 



