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evL*r, we mufl treat the patient antiphlog-ifticallr, prcfcribe a 

 fpare di.t, and alfo, it the cafe fhould require it, adniiiiiltcr 

 opiate's aiul laxitlves. For lefions of tlie nerves, tlie appli- 

 cation of warm fpirit of turpentine is corameaded ; but it 

 would probably be nfcful only in cafe the nerve fhould lie 

 above, but hardly when under, the vein. Over the oriiice 

 we apply feme lint and a niUd plaifttr, and over this and the 

 whole limb, emollient and dilciuient cataplafms, with which 

 anodyne remedies are mixed. 



If, notwithftandiiig this treatment, the fymptoms fliould 

 become more violent, the lips of the wound acquire a bard- 

 iiefs, and become more inflamed, affefted with pain and tu- 

 mor, with a full and quick pulfe, blood mull be drawn by 

 leeches, or at another place by venefeftion. Inftead of the 

 warm emollient fomentations and cataplafms, which are re- 

 commended in fuch cales, Mr. B. Bell extoUs, from his own 

 experience, cooling allringent remedies. Preparations of 

 lead he has found moft ferviceable. The parts which fuffer 

 the moll may be covered alternately with cloths wetted with 

 a folution of faccharum Saturni, and with pledgits ipread 

 with ceratum Saturni. The fever mull alfo be particularly 

 attended to, and the above mentioned cooling treatmicnt 

 continued. When the pains are fo violent, that they en- 

 tirely deprive the patient of fleep and reft, we muft ufe an- 

 timony and opium ; but in order that the opium may prove 

 ferviceable, it is adminillered always in coi.liderable dofes. 

 The limb muft be alfo kept continually at reft, and in a ho- 

 rizontal poilure. 



But frequently the firft afFeftion is ncglefted, or improper 

 remedies are employed, fo that opium, and all the remedies 

 that have been mentioned, have not the fraalleil efrecl. This 

 is particularly to be fuppofed, when the nerve is cut in fuch 

 a manner, that only a part of its fibres ilill remains entire, and 

 thefe are preternaturally ftretched ; in which cafe the whole 

 body fuffers, and the moft violent convultive affections take 

 place, «l)!ch indicate the moll imminent danger. The only 

 remedy under thefe circumftances is the divifion of the nerve 

 by a tranfverfe inciiion above the inflamed part, that is to fay, 

 higher than the orifice of the vein. As the nerve certainly 

 lies within the breadth of the orifice of the vein, the incifion 

 needs not be long, and it mull penetrate only down to the 

 lafcia of the fure-arm, for all its cutaneous branches always lie 

 on the outfide of this fafcia. 



Mr. Benjamin Bell has given very extraordinary direftions 

 on this fubjecl, which have (moft unaccountably) been tranf- 

 cvibed by manv furgeons in France and Germany : he directs, 

 among other things, an extenfive tranfverfe incifion to be 

 made through the original wound, and even down to the 

 bone ! which Mr. Abernethy has very properly reprobated 

 as " dargerous and unneceffary." 



When the branch of an artery has been wounded, the pa- 

 tient does not feel more pain than ufual ; but the furgeou 

 immediately concludes from the colour and fpouting of the 

 blood what fault he has committed. See Aneurism. 



In veneftcticn, a bone may alfo be injured, chiefly w ith lean 

 perfons, v/ho generally have very thin veins, efpecially on the 

 feet ; which, though they arc very vifible, lie, however, fo 

 clofe upon the bones and tendons, that the inftrument pafles 

 through and injures the fubjacent bone. In moll cafes, this 

 only occafions a pain which the patient feels during the opera- 

 tion, and no bad confequences enfue. Frequently the fur- 

 geon himfelf would not know it, did he not find, on examin- 

 ing the inftrument, that the point is ertirely wanting, or at 

 leall bent round, and its edge fpoiled. This, however, ap- 

 plies only to the cafe where none of the iron is left in it ; but 

 when this happens the cafe is worfe. We may know that it 

 tas taken place from the cutting blade feeing wanting, or in 



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part broken off; from the pain which the patient feels, and 

 which is generally of a p'jlfating kind : from the divided 

 ft ream of the blood ; from the feel with the fingers, when 

 thty are ftroked over the orifice of the vein, and from the re- 

 boundmg which the furgeon feels in the fingers at thellroke. 

 If it is not ft-atedvery firmly, the ftream of blood generally 

 drives it out, if we draw the orifice gently afundcr with two 

 fingers. But when it is more firmly feated, we muft endea- 

 vour to draw it out with a fine pair of forceps as cautioufly 

 as pollible, that it may not break in extratling, and the point 

 remain flicking in the bone. When it has been fucce.''sfully 

 extrafted, we mull endeavour to prevent the fymptoms, fuch. 

 as inflammation, tumor, Sec. by moiftcning the comprefs and 

 the bandages with a difcuticnt lotion, and afterwards alfo 

 keep the bandages moiftened with fuch remedies throughout 

 the day. This accident is only liable to occur in ufing the 

 fleam. 



But the breaking ofi"the blade may alfo happen with muf- 

 cular fubjeds, and this the furgeon can certainly in general 

 prevent, by always infpefting his inftruments carefully, and 

 providing them with good blades. The beft blades are thofe 

 which are very fliarp and finely polifhed, and thefe are gene- 

 rally very thin, and confequently moft liable to fly off. Before 

 we ufe any blade, efpecially a thin one, we ought always to put 

 it to the following teft. We fcrew the new blade into the 

 phleme, and let it fly two or three times without anv objeA 

 cppofed to it. If the blade remains as it fhould, we are thea 

 fomuch the more fecureagainft its flying off in bloodletting, 

 becaufe it has a refillance oppofcd to it. T-his precau- 

 tion fliould never be negletted, and the lofs of a few blades 

 fhould not be regarded, in order to fecure ourfe!vc3 againft 

 the danger to which we are expofed, if we negledl it. Thefe 

 obfervations and precautions will fcarcely be wanted for 

 Engltfi} furgeons, who have laid afide that inftrument. 



Sometimes a lym.phatic veflfel is wounded ; in which cafe 

 the patient experiences no extraordinary pain, nor does the 

 furgeon forefee the injury that is ftill to arife, and confe- 

 quently cannot be immediately difcovercd. After the ban- 

 daging, the vein heals up, no inflammation is left behind, but 

 there daily flows out of the orifice of the Ikin a quantity of 

 clear pellucid lymph, which continually keeps the dreflings 

 \vet. This circumftance often gives the furgeon much 

 trouble. Here we may apply witii advantage Goulard's 

 falurnine water, or a folution of alum, or mere cold water. 

 The cure is beit completed by means of dry lint, applied daily 

 once or twice in the form of a tent. We may alio fpiinkle 

 pulverized alum, or apply a ftrong preflTure upon the vefl'el ; 

 and fomctimes we may ufe the lapis infernalis with advan- 

 tage. Mr. Jaeger, however, thinks ( Funfzig. chirurg. prakt. 

 Cantelen. &c. Frankf. a M. 1788, p. 3.) that the cure may 

 moft fpeedily be effefted by immediately promoting fup- 

 puration. 



It may happen, that in letting blood at the arm a lym- 

 phatic veflel becomes inflamed ; in which cafe we feel upon 

 examination, a hard abforbeut veffel both above and below 

 the wound of the vein, which laft, however, is not yet healed, 

 but generally uninflanied : if the affedcd limb is ufed, the 

 pains become more violent, and fomctimes extend themfelves 

 into the axilla, where alfo the glands fwcU ; generally the 

 fore -arm likewife fwells and bfCom.es painful, and at lall ab- 

 fcefTcs take place in different parts. Befides keeping the 

 affefted arm at reft, we niufl cover the wound with an 

 emollient ointment, and apply to the hard veffeW and tumors, 

 cataplafms of emollient, difcutient, and anodyne remedies, 

 upon which they are generally difculfed. When abfcefTcs 

 have already been formed, they muft be opened and healed, 

 according to the rules of the art. See Abscess. 



The 



