SURGERY. 
a little below tlie place where it is designed 
to introduce the lancet. Tliat instrument 
should be pushed obliquely into the vein, 
and when its point is a little within the ca- 
vity, the opening may be rendered suffi- 
ciently large, by carrying the front edge 
forward and upward, so as to bring it out 
of the part. In many cases, where we wish 
to make a sudden impression on the vascu- 
lar system, we make the opening longer 
than usual, that the blood may be with- 
drawn more suddenly, and cause fainting. 
The stream may be accelerated by putting 
the muscles of the fore-arm into action. It 
stops when the ligature is removed, or at 
least, if the surgeon press with his left 
thumb below the vein. The sides of the 
incision should be placed in contact, and 
maintained in that condition by a small 
compress of linen, bound on with the bleed- 
ing fillet applied in the form of the figure 
of eight In opening tlie external jugular 
vein, the pressure must be made with the 
surgeon's finger ; and the compress should 
be fastened by means of sticking plaister. 
The temporal artery may be opened by a 
simple puncture ; and the bleeding may al- 
ways be stopped by a compress fastened 
by means of sticking plaister. The opera- 
tion of bleeding may be followed by, various 
unpleasant consequences ; as ecchymosis 
round the vein, inflammation of the mtegu- 
ments, absorbents, fascia, or vein itself. 
The former symptom- generally disappears 
of itself in a week or ten days ; the others 
may be treated according to the general 
principles of surgical practice. 
PARTICULAR FRACTURES. 
We shall say a few words on the most 
common and important kinds of fracture. 
Fracture of the lower jaw may be detect- 
ed by introducing a finger into the month, 
and pressing on the front portion of the 
bone, while the fingers of the other hand 
are applied on the outside to the back of 
the bone. Alternate pressure in these situ- 
ations occasions a very distinguishable cre- 
pitus, When the broken ends are adapted 
to each other, some wetted pasteboard is 
to be applied along the outer surface and 
base of the bone ; and over this a bandage, 
w ith four tails, should be placed. The cen- 
tre of this bandage is applied to the chin : 
the two posterior tails tied together at the 
top of the head, and the other two more 
posteriorly. The wet pasteboard adapts 
itself to the figure of the part, and consti- 
tutes, when dry, a splint exactly accommo- 
dated to the form of tlie jaw. All motion 
of the broken bone should be avoided ; 
hence talking, chewing, &c. are improper ; 
hence, too, the food should be soft, and in- 
troduced by a spoon. 
The fracture of the clavicle is attended 
with a displacement of the bone ; its scapu- 
lar portion being drawn downwards and for- 
wards. In order to restore it, let the shoul- 
der be drawn backwards, and the arm 
raised ; then the surgeon should place the 
fracture in "as even a position as he can, co- 
ver it with a piece of soap plaister, and keep 
the shoulder back by means of the figure 
of eight bandage : the fore-arm and elbow 
being well supported by a string. A lea- 
ther apparatus lacing behind, and having 
straps to pass in front of the shoulders, si- 
milar to the instruments used for girls with 
the view of keeping the shouldere back, is 
a more effectual mode of accomplishing the 
object. , 
It is often difficult to detect fracture of 
the ribs. By placing the fingers where 
pain is felt, or where the blow was re- 
ceived, a crepitus can be distinguished in 
many cases, on making the patient cough ; 
yet if the matter be doubtful, the safest, 
plan is to treat the patient as if his ribs 
were broken. It will be readily seen how 
emphysema, extravasation of blood, &c. 
may occur when the bone is displaced in- 
wardly. Our object is to keep the broken 
ends motionless. Hence, after a jnece of 
soap plaister has been applied externally on 
the situation of the fracture, a broad roller 
should be put firmly round thfe chest ; or 
we may apply an apparatus made expressly 
for the purpose, consisting of a broad girth, 
with three or four buckles and straps, 
which maybe tightened at pleasure. Bleed- 
ing is proper, unless particular circum- 
stances contraindicate it. / 
In fractures of the os brachii, after re- 
storing the limb to its natural figure, and 
putting on a piece of soap plaister, apply a 
splint, lined with a pad of soft materials, 
from the acromion to the external condyle, 
and another from the margin of the axilla 
to the internal condyle. Some add tw'o 
others, one before and one behind. They 
must all be carefully fastened with tapes; 
and the fore arm and liand should be well 
supported by a sling. There is always, a 
distinguishable crepitus in fractures of the 
fore- arm .j After a piece of soap-plaister 
has been applied, two splints must be em- 
ployed : one is to be placed along the in- 
side, and the other along the outside of the 
