SURGERY. 
-748 
opposite sides of the vessel, the artery* even if 
contiguous, must necessarily remain uninjur- 
ed. In performing the operation, the thumb 
of the left hand is to be pressed firmly on the 
vein to be opened, a little below where the 
lancet is to enter ; the instrument then being 
opened at about right angles, is to be laid 
hold of about half way down Us blade ; the 
surgeon is to rest his hand on the patient’s 
arm, and to make the opening in the vein in 
somewhat of an oblique direction. When 
sufficient blood has been withdrawn, the liga- 
ture is immediately to Ire taken off, the arm 
cleaned with sponge and water, a dossil of 
lint, or piece of linen doubled, laid neatly over 
the orifice, and the tape bound over this in 
such a manner as to inter fere, as little as pos- 
sible with the bend of the elbow. 
When it is found impossible to bleed in 
tins part of the arm, one of the veins may Ire' 
pierced between the elbow and wrist. In 
this case the tape of course should be bound 
round below the joint. 
When bleeding is required in the neck, the 
thumb is to be firmly pressed upon the ex- 
ternal jugular about an inch below where the 
opening is to be made. 
If venesection be required in the ancles or j 
feet, a ligature is to be bound round a little j 
above the ancle joint ; the veins of the feet ; 
are usually prominent and superficial. The 
one that is most so is to be made choice of. 
Adhesive plaister is to be laid over the orifice 
when the 'operation is over. 
Artiribtomy is only practised on the tem- 
poral artery. In opening this artery it is ge- 
nerally advisable first to divide the skin 
which covers it, before the lancet is intro- [ 
duced ; the artery is then to be opened in the 
same manner as a vein : the discharge of 
blood may generally be stopped by cutting 
the artery directly across, and suffering it to 
retract. Bandages have likewise been con- 
trived for stopping the flow of blood, one of 
which is represented in fig. 7. 
Topical bleeding. 
Leeches, scarifications of the skin with the 
point of a lancet, and cupping, are the means 
emp]oj|jed for topical bleeding. Cupping is j 
pWiormed by the scarificator and cupping 
g|asses; the -scarificator is an instrument so j 
constructed, as, by means of a spring, several , 
lancets are made to apply at one time to j 
the vessels of the skin ; over these punctures ; 
the cupping-glass is to be evenly placed, the 
air of which lias been rarified by heat, as by 
burning a piece of paper dipped in spirits, 
and placing it in the bottom of the glass ; the 
blood from the wounded vessels will imme- 
diately rise and flow into the glass. When 
it is required to take more blood than will 
fill one glass, the surface of the wound is to 
be bathed in warm water, wiped dry, and the 
second vessel immediately placed over it in 
the same manner as before. 
It lias been observed, that the' flow of 
blood is facilitated in some instances by plac- 
ing the cupping glasses over the surface to 
be scarified previously to the application of 
the scarifying instrument; and dry cupping 
is sometimes practised, in which, by the mere 
use of the glasses without the scarificator, a 
quantity of blood is diverted from other parts 
without being discharged. 
Leeches are most easily applied by confin- 
ing them under a wine glass; it is thought 
that these animals fix more readily if the sur- 
face be previously rubbed over with milk, or 
cream, or sugar. 
Issues. 
The most usual parts of opening an issue 
are on the fore part of the humerus, the hol- 
low above the inside of the knee, the nape 
of the neck, the spine or between the ribs ; in 
the two former places the pea or blister issue 
is commonly used, in the others the cord or 
seton. 
A blister issue is made and kept up by the 
common blistering plaster being first applied, 
which is followed by the daily use ot can- 
tharides ointment. The pea issue is some- 
times made by caustic, but more commonly, 
and much better, by pinching the skin up, and 
cutting it through, making a wound of suffi- 
\ cient size to receive the common issue pea ; 
! this is to be daily removed, a fresh pea put 
into the wound, and thus a purulent dis- 
charge will be excited and maintained. 
The seton is. to be made with the seton 
needle, (fig. 8.) threaded with cotton or silk, 
this is to be pushed into the skin, and carried 
out at some distance, passing the instrument 
fairly through ; and a few inches of the silk 
or cord that may be employed is to be left 
hanging out from the orifices ; the cord is to 
be daily drawn out and renewed. 
Diseases of the eyes. 
Inflammation of the eyes is of two species ; 
the one called by systematics, opthalmia 
membranarum, inflammation of the mem- 
branes of the eye ; the other, opthalmia tarsi, 
inflammation of the eye-lid; the latter is a 
glandular and scrophulous affection. Mem- 
branous inflammation is to be subdued by 
saturnine lotions, by bleeding with leeches on 
the temples ; and if the disorder be violent, and 
the inflamed vessels very turgid, by cutting 
the vessels across upon the eye. Light, and 
all qt,her sources of irritation, it is hardly ne- 
cessary to observe, should be kept from the 
eye as much as possible. 
Opthalmia tarsi is best treated by rubbing 
over the lid, when the eye is closed, some 
one of the . active mercurial ointments, of 
which perhaps the most efficacious is the 
ling, hydrargyri nitrati of the London Phar- 
macopeia. 
Membranous inflammation, if violent or 
long continued, is apt to be followed by 
specks on the cornea ; these may sometimes 
be removed by absorbent remedies, local or 
general, such as calomel thrown into the eye 
through a quill, or small quantities taken in- 
ternally so as to produce a very gentle mer- 
curial action in the system. Sometimes, when 
the speck on the cornea is very prominent, it 
may be removed by a small knife. When 
tlie membranous excrescence termed pte- 
rygium, spreads from the white of the eye 
over the cornea, a scarification should be 
made through it entirely round, and at a little 
distance from, the circumference. After the 
hemorrhage has subsided, a saturnine lotion 
is to be applied to the eye. 
Inllanmiation now and then terminates in 
an abscess of the eye, which confounds the 
humours, and destroys vision ; in this case the 
matter must be evacuated by an incision into 
the cornea. Ulcers of the eye may. arise 
from the same causes, constitutional or local, 
that occasion ulcers in other parts: the ^ge- 
neral principles of treatment must likewise be 
the same. 
The aqueous humour of the eye sometimes! 
accumulates inordinately, and constitutes a 
kind of dropsical swelling of the organ; this' 
disease is to be distinguished from abscess! 
by the manner in which it has been produ-J 
ced, by the patientremaining more or less sen • j 
sible to light, and by the pupil contracting, j 
Dropsy of the eye may be remedied in its 
early stages by puncturing the under edge of 
the cornea, or by piercing the schleratic coat-j 
just behind the iris. After the operation, sa- \ 
lurnine and astringent lotions are to be used. J 
It is sometimes necessary to puncture thej| 
eye, in order to discharge blood that, may! 
have been extravasated i'rom its vessels and! 
remain unabsorbed. 
When the eye has become cancerous, the] 
whole of it is to be dissected out, free from] 
the lids, if the operation is performed before 
these parts have become diseased. 
Cataract. This is a disorder either of the] 
crystalline lens or of its capsule, preventing I 
the rays of light from falling upon the retina. 
Cataract usually commences by a dimness > 
of vision, followed by the sensation of par-1 
tides of dust floating before the eyes, which 
is at length succeeded by almost total blind- 
ness. This disorder is usually without, but 
is sometimes accompanied with pain. It is 
distinguishable from the gutta serena by the 
opaque appearance of the lens, which in the 
last disorder is not present. In gutta serena 
the pupils do not contract in a strong light ; 
in the cataract, the contraction of the pupil 
usually remains. Whether the capsule mere- 
ly, or the body of the lens, is affected, it is 
not easy to ascertain. 
In the commencement of cataract, advan- 
tage hag sometimes been experienced from 
small doses of calomel, hyoscyamus ; cicuta 
and electricity have each been used with sup- 
posed benefit. When the disorder is con- 
firmed, it is only to be removed by an opera- 
tion, by couching or extraction, by forcing 1 
the opaque lens down into the vitreous hu- 
mour, or by taking it entirely out. 
Of couching. “ The operator is either to 
be seated with his elbow resting upon the ] 
table, or, which is preferred by some, he ought 
to stand resting his arm upon the side of the 
patient. The eye being fixed by the specu- 
lum, (fig. 19.) or in such a manner as to al- 
low the whole of the cornea and a small por- 
tion of the scleortie coat to protrude, at 
couching needle, (fig. 21.) is to be held in' 
the right hand in the mariner of a writing 1 
pen, if the left eye be the subject of the- 
operation ; the ring and little fingers are to 
be supported upon the cheek or the temple 
of the patient ; the needle is to be entered in 
an horizontal direction through the sclerotic 
coat, a little below the axis of the eye, and’ 
about one-fourth of a line behind the edge of 
the cornea, so as to get entirely behind' the 
iris, to prevent that substance from being 
wounded. The point of the needle is to be 
carried forward till it be discovered behind ’ 
the pupil. The operator is now commonly ! 
directed to push the point into the lens, and 
depress it at once to the bottom of the eye, ' 
but in this way the lens either bursts through; 
the capsule at an improper place, or it carries” 
the capsule with it, tearing it from the parts 
with which it is connected. Instead of this, 
the needle ought first to be pushed into the 
