B L E 



The rnoft common fvmptomconreqiientiiponblood-ktt'ng 

 is fainting, wnich, iiowtver, isii. mofl cafts unattended with 

 d'.tngfi", clptcially when it does not arife from a too copious 

 ev icuation of blood. It may often be prevented, by keep- 

 ing the patient engaged in converfallon, by letting him take 

 a ipoonful of vinegar, or a glal^ of cold water into his mouth 

 or fpriiikHng liim and wafting his hands and face with it. 

 But if it nevertlulrfs fiipervenes, we muH immediately place 

 the patient in a horizontal pofition, throw open the chamber 

 window, and apply ftrong ftimnlating fubflances, fuch as 

 volatile alkali, to his noftrils ; and when he has come to him- 

 felf, we may give him a ulafs of wine, provided it be not con- 

 tra-indicated by his ill ilate of liealth. 



With perfnns who always faint whenever they are bled, 

 and wlio on this acccount, liowever neceffary tlie operaiion 

 may be for them,, always dread it, the beft method of prevent- 

 ing their fainting, is to lav them immediately in a liorizontal 

 pofition, with the head low, and at the fame time frequently 

 to flop the dilcharge of blood by holding the vein. This 

 caution is particularly to be reconimended with pregnant 

 women, as faintings and convulllons in them, if they continue 

 too long, may prove very injurious to the fcetus, or produce 

 abortion. 



We have hitherto confined our remarks to the opening of 

 a Vein : it therefore now remains ior lis to defcribe the 

 operation of Arteriotomy, which is the artificial opening 

 of an Artery. 



This operation was very frequently praftifcd by the an- 

 cients ; who, perhaps, from having incorreft ideas of the 

 nature of thefe blood- veffels, were not always aware of the 

 dangerous confequences v\-hich follow from tiiis practice, if 

 injudici';uny managed. Thole who are dtfirous of reading 

 a full account of the ancient practice in this branch of lur- 

 gcry,may perufe what Oribafiushrs colleded from Galen and 

 Antyllus; to which they may add the obfervations ot 

 Paulus yEgineta, and Profper Alpinus, the latter of whom 

 defcribes the operation as it was performed in Egypt. 



The fuppofed advantages of opening an artery, rather 

 than a vein, are ift, that the blood flows with greater velo- 

 city than from a vein ; and therefore affords a larger quan- 

 tity in a given time : 2dly, that it prevents the accumula- 

 tion of blood in any local inflamation more effedlually, be- 

 caufe it intercepts the fluid in its pafTage towards the affedltd 

 .part : 3dly, that its falutary effctts more Ipeedily follow, on 

 this account, than from the operation of phlebotomy ; and, 

 'therefore, it is preferable in cafes of a very urgent nature, 

 fuch as apoplexy and phrenitis, arifing from the prefl'ure of 

 ■blood upon the brain. 



But thefe advantages are fpeculative, rather than practical, 

 for the ffjllowing reafons : ift. No turgeon who is ac- 

 quainted with the ferious confequences of opening a large 

 branch of an artery, and the difficulty of rcflraining the 

 effufion of blood in many inilances, will perform this opera- 

 tion in the fame parts of the body, and in tlic fame dauntlefs 

 manrer, as the ancients did. And in opening only very 

 fmall branches, (fuppofe of the temporal artery,) it rarely 

 happens that the blood flows rapidly, and never with the 

 fame freedom as it does from a large vein : 2dly, That we 

 may fom.etimes, by this means, intercept the blood as it 

 pafles towards an inflamed part is certain, by cutting 

 through the principal artery which conveys the blood ; but 

 (this advantage is not often obtained, bccaufe we dare not 

 divide any confiderable ramification, and there are always 

 more arterial btanches than one to fupply an impoitant or- 

 gan : 3dly, We admit, that in certain cafes, (in ophthalmia, 

 or inflammation of the eyes, for example,) the good cffecls of 

 blood-letting by arteriotomy near the afiefted part, is far 



B L E 



more ufeful than by phlebotomy, in a femote part ; but, 

 unfortunately, the furgoo'i cannot always evacuate a fufTi- 

 cient quantity of blo'd hy this means, on account of the 

 difficulty of tinding a fitUahle branch of an artery, which 

 may be eafily as well as fafely incifed. 



Therefore, confiJermg all the dilidvantages of this opera- 

 tion, it is now very rar.ly p'atlifed, except in the temples, 

 vvh.-re the pulfation of a fmall branch of the artery may be 

 often felt with eai'e ; and there is little or no danger in at- 

 tempting to divide it. If we do not Incceed in our attempts, 

 or do not procure fo mueh blood as is requifite, the opera- 

 tion of phlebotomy may then be had recourfe to. It fiionld, 

 however, be mentioned as an undoubted faiSt, that acute 

 inflammations of the eyes, are more tfttftually relieved by 

 arteriotomy, (when it properly fucceeds,) than by opening 

 a vein in the arm ; and that the excretion of four ounces of 

 blood in this way, is as ufeful as twenty or even thirty 

 ounces taken from the venous fvftcm ! 



As arteriotomy is now fcarcely ever performed in any other 

 part of the body befidcs the temple, we fliall content our- 

 felves with defciibing this operation alone. In that fituation, 

 the artery lies near er.ougli upon the cranium to be com- 

 preflcd readily, when we wifli to flop the current of blood ; 

 though, in general, the blood does not flow fo freely, as to 

 caufe any ditficulty in relfraining it by moderate preffure. 



The patient being placed in a good liglit, the operator 

 feels for a puUating veflel in the temple, nearly oppofite the 

 outer angle of the eye. When he has difcovered it, he en- 

 deavours to trace the dirctfion in which it runs ; and then 

 he places the two foremoll fingers of his left hai.d upon the 

 artery, leaving a fpacc of about halt an inch betu een them for 

 the place of the incifion. The veffel is fo fmall, in general, 

 that it cannot be opened by an oblique, or a longitudinal punc- 

 ture, as in bleeding the veins of the arm ; but muft ulually 

 be cut acroff, by a fingle llroke of the lancet, or fcalpel. 

 A lancet is not fo convenient as a fmnll knife for this pur- 

 pofe, becaufe its fine point is apt to be broken ; and it will 

 be found bell to draw the inftrument over the artery, inftcad 

 of endeavouring to flrike it with the point, (which Dr. But- 

 ter, Mr. B. Bell, and others, dirett to be done,) as in phle- 

 botomy. It may be convenient to make a little impreffion 

 with the finger-nail, or with ink, on the exaft fpot we deter- 

 mine upon for the incifion, lell we lofe our objeft in opera- 

 ting ; for a furgcon cannot alvvays enfure the divifion or 

 wounding of the artery on his firll attempt, efpecialiy if the 

 incifion be made with timidity, or helitation. 



When a luiHcient quantity of blood has flowed, 

 (which it does by a florid and falient iiream,) we clofe the 

 wound ; and apply a Ion.; bandage over a very firm, thick 

 comprefs of linen, in which may be included a piece of coin, 

 or fome other hard fubftance. It is a matterof fmall import- 

 ance whether or no we firll ufe an adhefive plaller, except 

 when the bleeding is hkely to prove troublef nne : but the 

 differe t modes of arrelling arterial hemorrhages, are^ de- 

 fcribed under the articles Hemorrhage, Ligature, 

 Styptic, and Aneurism. 



Frequently it is neceflary tliat the furgeon fliould make 

 himfelf acquainted with the ftateofihe blood, and often alfo 

 it is required of him to pafs his opinion upon it. As long 

 as the blood is warm and flows out of the vein, it exb.ibits a 

 pretty uniform red colour, and has a vifcid gluey feel ; but 

 when it grows cool, it coagulates into a mafs varying in co- 

 lour and denfity. Alter Ionic hours, there gradually exudes 

 from this coagulated mafs a fluid, which feparates the more 

 fohd parts from the fides of the veflel, fo that it fwims in it. 

 Thia water is called fcrum, but the coagulated red cake 

 is named cruor or traffamentuin. 



. Good 



