B L E 



B L E 



rfmove tTie red bandage and hanp; it over t^e clmir, or the 

 fliouidcr of tliL- patient. The afTiilant takt<; away the vcfTcl 

 into which the nKiuJ has been received, and the operator 

 now with a moderate pren"u'"e dra-vs the fpon;re froiii the 

 vehi towards the hind in a right line with the oiilici that 

 has b.;en made ; and it will be proper, whilll he britirrs the 

 lip=i of the wound together with the thn:nb of h's left hand 

 from the fult-, to repeat the wiping with the fponi^e once 

 more, in order completely to remove the blood that may 

 have been left in the orifice. 



When the fur^eon now fees the vein well clofed, he lays 

 upon it the co-npiefs, with the finders of his riirht hand, 

 vvhilft he draws it towards the thumb of the left hand upon 

 the (l<in ; and when the middle of it is upon the orifice, he 

 preflei it down with the fore and middle fingers of the ri:Tht 

 hand, and immediately changes thefe for the thumb of the left 

 li;t--d. With the right hand he waOies the blood from the 

 limb, by means of the fponge; after which, he lays the 

 fponge afide He then takes the bandage out of his left 

 ha-id, lays hold of it with the fore and middle fingc s of the 

 right hand at the inner part of its head, and the thumb upon 

 the outer, and places it upon the comprefs in fuch a man- 

 ner that the fingers of the left hand make way for it, whilll 

 the two fingers of the right hand continue the prefliiie in 

 their place. But, immediately after, thefe arc ag -.in changed 

 for the left, fore, and middle fingers, which now prefs at 

 the fame time upon the one turn of the bandage and the 

 comprefs. The right hand carries the bandage crofs-ways 

 round the arm, whilll file fore fingers of the two hands 

 always alternate, till the laft, when both ends of the ban- 

 dage are either fewed, tied, or pinned together. 



Notvvithftanding we have given thefe very precife direc- 

 tions, a young furgeon will learn better by feeing the 

 operation performed by a fl;:lful hand, than by any verbal 

 inlirudlions. 



Tying the vein upon the thumb is performed in the 

 following manner: — Preffing with the comprefs, which 

 here mull be pretty narrow and thick, is like that performed 

 on other veins ; and therefore, whilll we hold it fall upon 

 the wound of the vein with the two fore fingers of the left 

 hand, we let the bandage, (which is rolled upon one head, 

 an inch in breadth, four feet in length from the end to the 

 place where it touches the comprefs), hang about half a foot 

 down over the back of the hand, obliquely from the wrill 

 outwards; carry the head of the bandage, after preffing 

 it over the comprefs with two fingers of the left han ', 

 through between the thumb and the fore-finger, over the 

 palm of the hand ; and, proceeding over the back of the 

 hand, cover the end of the bandage : then go round the 

 wrill, again over the back of the hand, under the thumb, 

 and now round the ball of the thumb ; again over the turn 

 that has ju!l been made acrols the back of the h<(nd; and after 

 having once more earned it half round the wnft, pin both 

 ends together on the back of the hand. We may alfo apply 

 this bandage with varied turns. In a fimilar manner, with 

 turns round the little fingr, and circular turns round the 

 wrill, the band;ige is applied, when the vena falvatclla is 

 opened. 



With the veiis of the foot, the common bandaging is 

 made by the Stapes, which, however, fometim.cs requires 

 a peculiar method, that ev ry one will cafily be able to 

 adapt according to circumllancts. The bandage may be 

 applied fomev/hat ti-ghtcr than upon the arm : however, on 

 account of the injurious confequences, which m;iy even be 

 attended with danger, the bandage mull not be drawn too 

 tight ; but it will be better fome hours after to examine it 

 again, and if neceffary, draw it fomewViat tighter. Upon 



the whole, it is-to be recommended, if poflible, in all blood- 

 letting operations, efp.-ciaily in arteriotomy, that the fur- 

 geon (siould fee the p iti-nt again fome hours after; as he 

 may obviate leveral i'mali inconveniences, which after-,>'ards 

 frequently occalion unpleafant complaints. 



Venefedlion is more rarely performed upon the frontal 

 vein, the veins under the tongue, and upon the neck. For 

 the frontal vein, when it requires to be opened, we apply a 

 bandage, or a garter or cloth, rou;id the neck, lay the mid- 

 dle of the bandage upon the back of the neck, carry both 

 extremities over the throat, and loiuid again to the back of 

 the neck, where an aflilant takes- one end in e?.ch hand. 

 This the patient may alfo perform himfelf ; only then the 

 middle of the bandage mull be apphed to the throat, the", 

 two ends carried round the neck till they meet at t«e 

 throat again ; there the patient holds them with both his 

 hands, and, according to circumllances, draws the bandage 

 tighter, or relaxes it, fo as ftill to retain fufficient fpace for 

 relpu-atlon. A ill'l more convenient mode of diilending the 

 veins of the neck, &c. is to pafs the bandage over the fides 

 of the neck, and under the oppofite arm-pits, fo as not to 

 prefs upon the trachea, which may impede refpiration ; then 

 hold the fvvelled vein down with the thumb or linger of your 

 left hand, a little below the part allotted for tlie operation. 

 The incifion is to be made, when the vein is fufEciently 

 tumid, with a lancet. 



In order that the blood may not run down upon the face, 

 we prefs a card bent crooked under the orifice upon the flcin, 

 and thereby conduft the blood into a veflel. After a fufn- 

 cient quantity of blood hat been difcbarged, we remove the 

 bandage from the neck, when the bleeding geserally ceafes 

 immediately, and the orifice is fecured with llicklng plaifter, 

 or, if it fiiould be ncceffary, with a comprefs and Discai- 

 MEN bandage. 



When w-e have to open a fublingual vein, we mufl pro- 

 mote the efflux of the b'ood, as in bleeding at the forehead, 

 by the application of a cloth under the arms and acrofs the 

 fides of the neck. The orifice is made with the lancet, and 

 the incifion is continued till it feems large enough. In order 

 more conveniently to get at it, we hold br^ck the tongue 

 with a wooden fork, or fpatula. We may draw a filk 

 thread through the wound, in order to clear it from the 

 blood, wliich here eafily coagulates, ■ and at the fame time 

 to prevent the lips of the wound from adhering together, 

 and confeqnentlv to obviate whatever m.ight impede the flow 

 of the blood. When its flow mull be Hopped, we take off 

 the bandage, and let the patient hold fome fpirit of wine, or 

 common brandy, in his mouth. If the blood flows more 

 copioufly, we may difpenfe with the thread, and immedi- 

 ately remove the bandage from the neck ; alfo, when it is to 

 be lloppcd, apply a little alum or agaric to the wound, and 

 prefs it down fur a time ; or apply Lampe's comprelfory, 

 defcribed in I. Val. Heinr. Koehlcr Anleitung zum Ver- 

 bande, &c. I^eipzig, l 796, 8vo. Tab. V I. Jig. J. 



To bleed at tlie external jugular vein, the bandage is 

 likewife applied round tiie niek; againft the clavicle, and 

 upon the vein that is to be opened, a thick comprels is 

 placed, and the bandage drawn fomewhat together. The 

 thumb is placed upon the comprefs which lies upon the vein, 

 and the fore-finger over it, in order to fecure it and to (Iretch 

 the (kin ; we then take a pretty large lancet, and with it 

 open the vein in the ord'nary manner; only with this differ- 

 ence, that we mull introduce it deeper, and make the ex- 

 ternal orifice lager. To catch the blood, we make ufe of 

 a card, as in bleeding at the forehead. When a lufficier.t 

 quantity of blood has been drawn, we remove the bandage ; 

 after which, the lips of the wound generally dofe fponta- 

 6 neoufly. 



