B L E 



B L E 



Bleidikg, or Blood-letting, in Surgery, is t!ie arti- 

 ficial extraftion of blood from an Artery or Vein, for 

 medicinal purpofes. The operation of cutting an artery is 

 named Arteriotomy ; that of opening a vein is called 

 Venesection, or Phlebotomy. 



The inftrument iifed in this country for bleeding the hu- 

 man fubjeft,is denominated a Lancet ; though a phkme, or 

 Jle.im, was formerly employed, and is ftill very commonly 

 iiled by farriers in England, and even by the bed fnrgeons 

 ill Germany, &c. See the Plate oi Surgical Injiruments. Tiie 

 lancet, on thefe occafions, is ufed fingle ; but where the in- 

 tention is to puncture numerous fmall blood-veffcls at the 

 fame inftant, rather than any one confiderable vein or branch 

 of an arteiy, furgeons have recourie to an inftrument con- 

 taining many lancets, which is known by the name of Sca- 

 rificator. 



Leeches are often applied to a part of the body requiring 

 the local evacuation of blood ; ;ind in this cafe, as well as in 

 fcarifying, the operation is termed local bleeding, in contra- 

 diilindlion to general blood-letting by the lancet. 



Some nations, efpecially thofe which have fcnrccly emerged 

 from a ftate of barbarifm, arc accuftomed to draw blood by 

 making one or more inciiions or punctures at random, with 

 a knife, a Hone, a tooth, or a needle. See Acupuncture, 

 Phlebotomy, Arteriotomy, Leeches, and Cup- 

 ping. 



The art of bleeding may be traced back to the remoteft 

 antiquity, and feems to have betn common among the 

 Egyptians, AfTyrians, Scythians, &c. at a time when ana- 

 tomy had never been cultivated. The Greeks boaft that 

 Podalirius, the fon of Efculapins, was the firil who prac- 

 tifed bleeding, foon after the fiege of Troy ; but the fact 

 itfelf is related by only one author (Steph. Byzan. in voce 

 Syrna), who lived too long afterwards to be credited impli- 

 citly. It is therefore much more likely, that bleeding had 

 been performed previoully to the time aliudcd to. Plin^', 

 indeed, fuppofes that phyficians fird learnt this operation 

 from having obferved the hippopotamus draw blood by pufii- 

 fng (harp reeds into its body ( Hift. Nat. lib. viii. cap. 26.) ; 

 but this is a very improbable thin^, as there is very little ana- 

 logy between the artificial opening of a vein with a lancet, 

 and the random wounding of an animal by friftion againft a 

 broken reed. 



We {hall, however, not enlarge on the hiftory of this 

 praitice, but proceed to dclcribe the common modes of 

 opening a vein in feveral parts of tiie body ; after which we 

 fliail treat of Arteriotomy. 



When v/e refolve to perform venefeflion, we muft.befides 

 the inilrumcuts required for that operation, have in readinefs 

 tine or two well-rolled blood-letting bandages, or tapes, from 

 four to eight feet in length, and of two fingers breadth, with 

 pins, or tile needles and thread. Thole bandages are, by 

 foreigners, reckoned the bell, which have narrow ftraps at 

 their ends. 



In general, venefection is praiftifed at the bend of the 

 elbow, or upon the f(.ot. Wlien the ];atient is to be bled 

 at the arm, we place him, with his face towards the light, 

 upon a chair of a moderate height ; draw his fhirt as high 

 as is necefTary above the elbow; let him extend his arm to a 

 certain degree, but not too much ; after which, the fur- 

 geon, in order that the veins may become turgid by check- 

 ing the circulation, applies a bandage (which is often made 

 d" line red cloth), of the breadth of three or four lingers, 

 twice round the arm above the elbow, with the ends of 

 V'hich, after having previonfly drawn them moderately tight, 

 he ties a bow with a fingle knot, at the poilerior part of the 

 arm. Whether this bandage has been properly applied, w« 



know by the circumflance, that the veins become elevated 

 and tumid, whilil tlie pulfation of the artery at the wrift is 

 diflinctly perceptible. 



We then choofe a vein in the bend of the elbow, which 

 mull be done with caution. 'I'he upper is the cephalic vein, 

 and this a beginner ought, if polTible, always to choofe, as 

 little or no danger is to be apprehended from opening it ; 

 but it is very feldom to be feen or felt, and commonly is too 

 fmall. The median vein is mod eaiiiy feen and felt ; but 

 generally the tendon of the biceps mufclc is Ctuatcd under 

 or at the fide of it, which we mull take great care not to 

 punfture. The inner vein of the arm, or the bafilic (which 

 in the right arm is by fome terrr.ed the hepatic vein, and in 

 the left the fplenic), is indeed commonly very eafy to be 

 feen, and ftill more eafy to be felt ; fometimes, however, it 

 is alio very fmall, or lies fo clofe upon the artery as to 

 render it hazardous to open it. 



Some recommend blood-letting upon the back of the hand, 

 although this is an inconvenient phce, and, in certain cafes, 

 not very fafe for the operation. But if it is to be performed, 

 we tie the red bandage two fingers breadth above the wrift, 

 round the fore-arm ; and, in order to raife the vein, let the 

 patient then hold his hand in warm water. The moft com- 

 mon vein upon tlic hand is the cephalic of the thumb, which 

 lies between the bones of the carpus, \suth which the thumb 

 and the fore-finger are joined. But the vena falvatella of 

 the middle finger, which lies between the two nietacaipal 

 bones with which the middle and the ring fingers are joined, 

 is at prefent but very rarely opened, and only when no 

 other is to be feen ; efpecially as it does not difcharge 

 much blood, is difficult to be tieJ, and, if cut quite through, 

 forms a thrombus. 



In bleeding thefe vein?, the patient muft be placed in a 

 fomewhat oblique pofition againil the light ; fo that when 

 the hand is halt clofed, and laid upon the edge of the vcftel, 

 the fingers are directed towards the light, in order that the 

 inftrument may throw no (hade upon the place of the vein 

 where we intend to open it. 



Bleeding at the foot is generally performed upon the vena 

 faphxna, which lies upon the firlt metatarfal bone, con- 

 nected with the great tee, running along it and the tarfus, 

 over the inner ancle. Where it lies clofe upon the ankle, it 

 is inconvenient to open, and we muft be very careful Icit we 

 cut through it and injure the perioileum, or even thrull the 

 fi^-am or lancet into the bone itfelf. Ifpoffible, it will be 

 better to open it one, two, or three fingers' breadths farther 

 from the ancle towards the great toe. We may alfo open a 

 branch far forwards, almoft clofe upon the great toe ; and 

 here we are reqnired often to open it with pregnant womea 

 who have fwelled legs. 



The othrr pretty fafe vein upon the foot h the cepha? 

 lica p.dis, that lies between the two tendons which extend 

 the great and the fccond toes ; only we mull be cautious 

 not to injure the tendon lying befide it. The other vein* 

 fitnated upon the back of the foot ftiould never be opened, 

 but in cales of extreme nccefiily ; tor the operation is at- 

 tended with danger, on account of the contiguous tendons ; 

 befides, they do not difcharge a fufficient quantity of bloodj 

 and they almoft always form a thrombus, which a beginner 

 (hould be careful to avoid. 



\Vhen we bleed at the foot, the patient ihould firft place 

 the limb in a pail of warm water, in order that the velTels 

 may be feen and felt ; and it is alio neceifary with fmall 

 veins to apply the red bandage, which, however, in order 

 that the purpofe of checking the flow of the blood may be 

 attained, and no inconvenience occafioned, muft be applied 

 in the middle of the calf, efpecially vviih Itaa peifons, ia 

 4 F 2 "the 



