B L E 



B L E 



Bcouflj'. Bul (hould a bandage be ncceffary, tt'e may fecui'C 

 a compvcfs upon it by means of two circular turns round 

 the neck. As this baudagc, on account of the preffure 

 upon the trachea and vcHcIs, Ac. of the neck, is always 

 very troublefoir.c ; and alio the prclfurc, as it never oiull be 

 ilrong, is frequently infufficicnt ; we may moll conveniently 

 -life the inRrunwnt inveiued by Mr. Chabert for comprtfling 

 the veins of the neck. In want of it, we mull Kt an affillant 

 clofe the orifice by preilure with his finger, till the danger 

 of hsmorrhaijc is over. 



.Some moillen the comprcfTes with br;injy, vinegar, Sec. 

 and thereby, on account of l!ic irrit.ilion, occafion lome in- 

 convenience at the orifice of the vein, in which fometimes 

 inflammation, a:iJ even a fuppuralion is excited. It is better 

 to apply the comprefs dry, or to Hick upon it a piece of 

 gold -heater's ikin, whereby the lips of the wound, if thsy 

 iiave been well brought together, arc retained in that ftate, 

 fo that the burlling open of the vein is more effeiilually 

 prevented. 



Eafy and infignificant as fume young furgeons think the 

 operation of phlebotomy, it nevcithelefs often requires the 

 greatell accuracy, and is on that account one of the mod 

 delicate operations. To a true furgeon, thereiore, it is al- 

 ways of inipoi tancc, and the more fo as his honour and re- 

 putation are endangered by committing an error in it. Fre- 

 quently the faults which the patient commits during and 

 after the op:?ration, fuch as incautious motion of the limb 

 v.'hilll the operation is performing, violent exertion of it, 

 drawing on boots, &c. after blood-letting at the feet,- are 

 afcribed to the negligence or ignorance of thi furgeon. In- 

 afmuch alfo as no operation occurs fo frequently as this, and 

 as it fu very often endangers the life of a man, or at leall an 

 error committed may give rife to fuch danger ; the furgeon 

 mud well conlider the fymptonis which occur in it, and 

 may fnperinduce more important confequences dangerous to 

 health, in order that he may timely obviate or remove 

 them. 



Sometimes there- arifes, as the mofi common bad confe- 

 quence of blood-letting, an inflammation of the external 

 integuments, and of the fubjicent cellular fubdance. Some- 

 times it is chronic, but little painful, fuppurates ilowly, and 

 produces a circumfcribed abfcefs. Sometimes it is more dif- 

 fufed, arid has the appearance of an erylipelatous inflamma- 

 tion .- fometimes it is violent and acute, and refembles a 

 pljlegmon. This generally occurs when the inilrument is a 

 bad one, and rather tears than cuts ; when the patient is of 

 a ver}^ irritable habit, and much difpofed to inflammation ; 

 when the reqnilite precautions for healing the wound by the 

 firft intention are negleclcd, and the arm is fuiTcred to be 

 m')ved ; v.hen the wound is externally rubbed, preffed, &c. 

 Tiie nature of this inflammation cannot be miiiaken, and it 

 muft be treated like a common wound. 



It may fometimes happen, that when the wound of the 

 vein does no; foon clofe, an inflammation of the vein takes 

 place, which however varies with rcfpetl to its violence, its 

 cxtenfion, and progrefs. In a milder degree, this inflam- 

 mation is followetl merely by a flight fwelling of the vein, 

 and an adhchon of !lb hdes. A violent inflammation induces 

 fuppuration. The common method of treatment is the anti- 

 phlogillic. As the internal membrane of the veins is conti- 

 nued to the heart, and as inflammations in fuch membranes 

 fpread eafily and rapidly, where they are not prevented by 

 an adhcfi()7i of the fides of the vein, it is in mofl; cafes ad- 

 vifable to produce fuch an adhefion by the application of 

 external prefTure at fome diilance above the orifice. If, 

 as may very eafily happen, fuch an inflamed vein fliould 

 pafs into fupn-j:„tion, it would (it known) then be neceflary 



to cut open the vein, in order to prevent the pus from mix- 

 ing with the circulating fluids. 



When a vein has been cut entirely through, the pain 19 

 not greater than common, nor does the patient experience 

 any inconvenience whilll the blood is flowing ; but a greater 

 or lefs quantity of it defcends under the vein into the adi- 

 pofe membrane, remains there inclofed, and during the firfl. 

 twenty-four hours occafions a tenfion. The external orifice 

 of the fliin may be difplaced from the orifice of the vein, 

 likewife, when the orifice of the integuments is fmaller than 

 that of the vein ; when the patient moves the arm too much, 

 in confequence of which fome blood is indeed difcharged 

 from the wound, but more penetrates between the vein and" 

 the flcin into the cellular texture ; and when the operation 

 has been abfurdly performed where two veins anaitomofe ; 

 from all thefe caufes an elFufion of blood may take place, in 

 confequence of which the part acquires a blueifh bkck co- 

 lour, and fometimes an ecchymoma, fometimes a fugillation, 

 and at other times a thrombus is produced. Although the 

 appearance frequently feems to indicate greater danger than 

 really exills, the fpeedy application of remedies is neverthe- 

 lefs neceflary. 



In the firfl; cafe, cataplafms, witli warm vip.egar, wine, 

 and other fpirituous or difcutient remedies, are ferviceable. 

 When fuch extravafated blond is not again taken up, or 

 v;heu the veffels are inadequate to its re-abforption, on ac- 

 count of its great quantity, an abfcefs is generally formed, 

 which mull be treated according to the rules of art, and the 

 fpirituous remedies laid afide. See Abscess. In the fu- 

 gillation, we mull endeavour to rem.ove the obflacles that 

 may impede the circulation of the blood : thefe are either 

 external ones, iuch as' a too tight bandage, by loofening 

 which the complaint is removed ; or they are internal ones, 

 and occafiontd by a contraclion of the veflels. In a recent 

 fugillation, we may combine the refolvent means above-men- 

 tioned with mild allringents ; and when the ilagnating blood 

 has been again diflfolved and removed, we at lall apply cold, 

 difcutient, and fpirituous remedies. 



When an aponeurotic part (for example, the fafcia of the 

 fore-arm) is wounded, the patient fometimes experiences a 

 more violent pain than ufnal, cfpecially when he moves the 

 limb ; and this he feels prelcntly after the blood-letting 

 has been performed. A comprefs, moillened vvitii cold 

 Goulard's water &c. is of fcrvice, whilft at the fame time the 

 bandage is left apphed for three or four days, and the limb 

 kept completely at reft, and wetted many times a day witli 

 fuch lemedies. When this is negUiled, there very often 

 takes place a ferious inflammation, which muil be treated ac- 

 cording to the antiphiogiftic plan. Repofeofthe limb, which 

 is to be kept in a bent pofition, and relaxation of the inflamed 

 parts by means of warm emollient applications, are abfo- 

 lutcly neceflary. As foon as the inflammation abates, it is 

 proper every day to attempt moving the joints, in order to 

 prevent a Itiffnefs. But if the tenfion and inflammatory 

 iymptoms run very high, it may even be rcqiiifitc to divide 

 the fafcia completely. 



When a nerve is injured, the patient experiences a flill 

 more violent pain, which extends itfelf throughout the whole 

 limb, and the patient is alfo apt to faint, the mufclcs of the 

 afl'ecled part coiitradl, and the blood fometimes does not 

 flow fo /reely as ufual, although the vein has been well 

 opened. The orifice of the vein does not become violently 

 inflamed, and the pain continues. In order to prevent in- 

 flammation and other fymptoms, a larger (juantity of blood 

 mull be let run out, the limb mull at leafl; for fome days be 

 left conpletely at reft, and we mull take care that the muf- 

 clcs of the part remain as much related as poflible. IMore- 



ovcr* 



