PHLEBOTOMY. 501 



safe to attempt to open it with the lancet. The fleam is always 

 preferable. If the bleeding is from the left yein, the instrument 

 is held with the right hand, the operator is placed against the 

 shoulder, fleam haviag its blade turned downward, the fingers 

 resting against the chest, and with a blow of the stick the vein is 

 opened. This bleeding is often accompanied by the formation of 

 a hematoma over the course of the vessel, due to the fact that 

 very often the fleam has opened the veia through and through. 

 This, however, is not a matter of any serious consequence. 



Phlebotomy on the Stiboutaneous Thoeaoic. 



This veia runs on the side of the thorax, on a level with the 

 sterno-trochineus muscle, and is readily discovered toward the 

 sixth or seventh rib. To render it more conspicuous, a bandage 

 can be appHed aroimd the chest, as suggested by Chabert, or by 

 carrying the leg of the side to be bled forward, and by rubbing 

 hard the tract of the vein, or even by simple pressure with the 

 fingers. 



The operation can be performed either by a simple punctm-e with 

 a lancet, or with a fleam, held parallel with the course of the ves- 

 sel, and between two ribs, to avoid breaking the instrument against 

 one of the bones. The bleeding is stopped in the usual way. It 

 is not unfrequently followed by the formation of a thrombus, 

 which generally disappears by pressure, or astringent local appU- 

 cations, and often by spontaneous absorption. 



Phlebotomy at the Inteenal Saphena. 



The comparatively large size of this vein, and its superficial 

 position, both explain and justify the fact that next to the jugular, 

 it is the one most commonly selected for the operation. For this 

 reason phlebotomy is indicated here, when it is contrar-iadicated 

 upon the vein of the neck. 



The saphena is formed by two branches, and in its course 

 crosses slightly the direction of the tibia in running upward on 

 the surface of the tibial aponeurosis, arriving at the flat of the 

 thigh, formed by the short adductor of the leg, and then dips in 

 the space left between this muscle and the long adductor, where 

 it empties into the femoral. In this course the vein is superficial, 

 covered only by a thin skin, from which it is separated by a thin 

 aponeurotic layer. It is at a point where the vein passes over the 



