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the fame manner as on the atiu ; but ihc bow and its krot 

 iiiiiil not he upon the tibia. 



On the arm, therefore, we chooft either the cephalic or 

 the median vein, and, if the tendon lyirg below it Diould oc- 

 tanon hcfuation, the bafilic, efpecially if this lies mors 

 convenient and Uiperficial. When the fi'.rpjtcn, thjn,' has 

 bvo'jglit his eye to the proper diilance from the vein, he wtts 

 the point of his middle fi;:ger, prefles gently with this fingjer 

 upon the vein at the places where he tl'.inks he can beil open 

 it, and accurately marks the place with, which he was iatis- 

 fied in trying by the feel ; after which he fuffers the arm to 

 fall down again into the patient's lap.. In the fame manner 

 he choofes a vein npon the hand. 



For blood-letting at the right foot, the patient is placed 

 upon a chair of a moderate height, in the moil L-p.hghtcned part 

 of the room, with his face directed towards the window, and 

 his feet imnieifed in a veffi.! filled witl; warm water, fo that 

 the water covers all the veins of the whole foot. When 

 therefore the foot is warm, and the veins fnfSciently tumid, 

 the furgeon lays hold of the loot with his left hand, and 

 places it with the middle of the io!e upon the edge of the 

 lelTel which is the mod remote from the body, in fnch a 

 manner, however, that the foot is not extended, but forms 

 a right angle with the kg. With the middle finger of the 

 right hand he examines thofe veins which lie the moll ele- 

 vated, and makes, according to the. rules before laid down, 

 a fcientific feleftion ; but he muil always firll direft his at- 

 tention to the vena faphxna. 



The moft convenient attitude for the furgeon is when he 

 kneels down with one knee ; as in this pofition the eye is 

 near to the vein, the pofition is firm, and can be better fup- 

 ported for the requifue length of time. If any other vein be- 

 iides the faphcena be chofen, the patient is diredled to move his 

 toes, whilll we are examining the vein, in order that we 

 may feel how near a tendon may he fituated below it ; and 

 here the cavition fliould be obferved, not to make all the fin- 

 gers wet, for the warm water diminilhes the fenfe of touch, 

 and confequently renders it indillind. We therefore life at 

 firll ordy one hand, btcaufe, in cafe of a failure, or from fome 

 other caufc, v.c may be under the neceffity of taking alfo 

 tlie other foot. 



The vein may be opened either longitudinally, that is to 

 fay, in the diredlion of its courfe, or we open it rath.er ob- 

 liquely or ti-anfvcrfely. The firft is the fafeft, eaficft, and 

 moft convenient method ; but it is admiffiblc only with large 

 veins, and when we forefee that during the operation they 

 ■will not flip or twitl, as it were, out of the way of the inftru- 

 inent. Commonly the veins are op-ned iomewhat obliquely, 

 and in this manner we may generally open the veins on the 

 arm, and in moft cafes upon the foot. But v/hen the veins 

 are too fmall, there is reafon to apprehend that we may not 

 hit them, or that they will not ditcharge a fufficient quan- 

 tity of blood ; and when their fituation requires it, as is (he 

 cafe with the cephalic of the foot (where it lies over the 

 tendon that elevates the great toe), the orifice muft be made 

 quite tranfverfely. 



When therefore we have properly examined the vein with 

 the moid finger, we hold the phlemc in readinefs (if we ufe 

 this inftrume-it); that is to (ay, we draw up the fpring, 

 take it in the right hand, fo that the thumb lies upon the 

 Aider, the fore-fine cr upon the bridge, and the middle fin- 



fer upon the preffer, exaftly over its fpring, and the rmg 

 nger upon the round part of the bottom plate. With the 

 fore finger and thumb of tlie left hand, which are moi.lencd 

 with a little faliva, we move the iron as high up iu the 

 groove as we think it necelfary to make rhe orifice deep ; 

 and place the box (after having again elevated the arm, or 



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taken the foot or hard out of the water, and fupported 

 them, in the manner above defcribed, upon the margin of 

 the vefTcl) in fuch a manner upon the fldv, that the ir.n has 

 exTidly the proper dircftion toward ti^e place wh.ere the ori- 

 fice is to b; made, and I'u.-n, by a gentle preffure with the 

 middle finger, let the fpring fly loole. 



If a perfon fiiould he fo fat as to render bleeding imprafti- 

 cable, and with fuel' it is at leaft very difficult to do it on 

 the foot, we may in fome meafure attain ou- purpolV, if we 

 dire('t the patient, as he gets out of bed, to hold his foot or 

 hand in warm water ; after vvhich th- veins will geii.-.aliy bsj. 

 come fuffieiently perceptible to the tje or touch ot au ex- 

 pcricnctd furgeon. 



But though the phleme is ufed for blood-letting, tfpecl- 

 ally in Germany, it is however an uiuvtria!ly acknowledged 

 truth, that the lancet is the I'afcll and beft ir.ftrument for the 

 purpofe. W^e run lefs hazard with it of doing damage, aud 

 the furgeon is always able, according as the circumfcances 

 require, to make the orifice either fmall or large. When 

 therefore we let blood with the lancet, we place it fo that 

 the handle forms a fomewhat acute angle with the bljde. 

 The furgeon next lays hi'ld of the limb upin which he is to 

 perform the ope»ation, fuppofc the right arm, with his left 

 hand ; and at the fame time preffes with the left thuirb upon 

 the vein, about two fingers' breadth below the place which 

 is chofen for the orifice: he then takes the lancet between 

 the thumb and fore finger of the ri.;ht hand, fo that fome- 

 thing more of the blade is uncovered than he thinks neccf- 

 fary to introduce. At the fame time he lets his ham! reft 

 upon the middle, ring, and little finger, wliicli muft be 

 placed as conveniently as poITible below the vein that is 

 to be opened. He then puflies the point of his lancet 

 carefully through the ilciu and integuments into the vein, 

 and carries the mllrument in an oblique direction a little for- 

 wards, till the orifice is fuffieiently large. But, during the 

 introduclion of the lancet, the operator muft hold the point: 

 as fteady and even as podible, in order that it may not pene- 

 trate into the fubjacent parti. S'lould he, however, not be 

 able to depend f.ifficiently upon the fteadinefs of his band, 

 he will do well to leave no more of the point of the lancet 

 uncovered than is to penetrate into the vein. The furgeon 

 having withdrawn his right hand, at the fame time re- 

 moves the thumb of his left hand from the vein, in order 

 that the bloud may flow out freely. 



If the blood will not flow properly, notwithftarding the 

 vein has been properly hit, either the orifice is too fmall, or 

 fat perhaps gets into the orifice of the integuments and 

 ftops it. The fat is to be preikd back, by llroking with a 

 wet and warm fponge, or by means of au iiulrument. The 

 impediment, indeed, may lie in the motion of the part j 

 when, for example, the arm is bent obliquely, or the foot is 

 placed in the watt-r, the orifice of the vein may eafily be 

 difplaced, and fome of it be clofed by the found part of 

 the fkip. but, finally, the circumftance may alfo be oeca- 

 fioncd by the vifcid confillence of the blood. To this latter 

 c.tufe it is often to be attr.buted, after the firft few minutes; 

 on which ^cci.unt it will be proper to wipe the arm, over the 

 orifice of the vein, with a fponge filled with v/arm water, 

 and let the hand reft in a fomewhat higher fituation than 

 the orifice, upon a ftick, which the patient may alfo turn 

 round, or prefs firmly with his fingtrs. 



When a fufficient quantity ot blood has flowed from the 

 vein (for example, in the arm'), and we are to tic it up, 

 we take the fpoiige, moiftened with warm water, in the 

 right hand, the bandage in the left, and the linen comurefs 

 between tiie thuTb and middle finger ot the fame hand ; we 

 huldagaiaft tiie vein with the fponge, and with the left hdud 



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