1000000031

' .

F IJr

:li

("'cn~derable

:\rtery lnd

lhe

brachil l nc,'ve lic nnder

rhe: h;:¡fi lic vein, and {he

lcndon of

the biceps

murcie

UI~J('f

tb~

median.

BUl

as they Ije {airer to

Ihe

eye,

~od

are lhere·

fore m\lre frequcndy the {ubjclls of lhe t\perations \Ve are

treating of than lhe

cephalic

vein, ir is {afer and more

eli–

gible

(Of lhe

Ids

expericnced

furgcons

OpOIil

the b",filic,

or al

lean

Ihe

median

Teio .

' Vhen you hate

determined

which veio ro open, you are

to perform lhe operation on tlut

pan

which pre(cnrs

¡t(elr

(JiTen

you. Hut

!he vein has freq uentl y beco opened.

aod

lhe

p~rt

which

flppC.tTS

lítrge1l2 nd

t..

trdl ,s

full of cica–

trices. you tire nln 10 open

.bove,

bUI

bdo\V lhe

cic;Hrices,

by "hieh

me.ns

the blood wiJl direharge ¡trelf more fredy:

:1-'or lhe

pOlI{

.bove

geneul y

nraiteD!!d

the c¡catl"ix.

Before you apply che lancet

the

fkio,

when the veirs are

not rifen. it will be proper to rub lhe arm below lhe baoebge,

which

wdl

drive lhe .blood back tO\Vlrds the cubil,

and

ren–

der the \'eins more lurgid.

W hil!l

this

doing in the right

arm, lhe furgeon (hould

take

hoJd of lhe pauent's

arm

{uch

a manner lhíl.t he m) y lay his thumu "pon lhe veio he

intends to open,

prevent lh: bJood from flowing back,

anJ

lOkeep lhe vein from rolling. You are now lO 6x ylJur

eye upon lh;u pan of (he \'eio which

you

intend to open ,

and t.llking lhe lancet with your right h.lnd,

placed that

t he thumb and fidl finger may be fi xed a"out the middle of

the

bl.de

; the other r.ngers (hollld ren genrl y UPOQ the p'.

tient's arm, to preven! you r hand (ro01 Oippir,g .

Your laneet is now tObe JÍuO,ed lightly .nd earefuJly for–

ward by your tho01b

~od

(ore-fioger; (il! it h;¡s penetnted

through the coalS o( the ycin ; and at that ioHaor to be rai–

red

liule upwards, in order tO enlarge the orifice of the

wouod, whieh \ViII give • freer

p.rr

'ge to the blood. The

mo'~

common "nd convenient

r.ze

of an orifice is about

,\Vice

tile breadth

the

b2.ck

of an ordinary kni(e. YOtl are

keepeven between Ihe t\'lO extremes of

rafh~efs

and limidity

m.king Ihe

punaurc:~

For as ia one cafe

y'!u

will ooly

divide

the comOlon integuments, aDd f.lleave your

w~rk

done; fo in the olher you will run the r¡fque of wouoJing

the an cry. nene, on endon.

You r "perture being thus made, and rhe innrument dra\Vn

in(hnd y

b.ck

, the hlood will ,hen ru(h lorth fro:n ,he ori

fi ce euhl r

a large or fmal! flnam . In the me.m time the

blood mul! be pnmitted 'o Bow as long.s it (h di be judged

ufe(ul or

necdr.l.ry

and ir it nlould flop

100

foon, as il oFten

may from lOO great a {tritlure of Ihe bandage on [he armo

mun be O.ckcned a I¡lde, by whieh mcans Ihe

cornprcl1~'d

ulery bei ng rel at liberty. ,he olood

\VIII

fl ow (rom Iheonfice

as .t lid\. If you find ,he

orir.ce

o',Hrutl<d by

' 00

great a

tenlion of lhe

Jkin,

oran intruhon orthe

f}J(l/lbralla

adl/,'1fd,

you oughl in

Ih~t

cafe

relu ro lhe bit of f.H, by prefñ ng

with lhe fince r or a warm f"onge, and

Icl04.x

Ihe fk in hy

bending the arm

liule. L aflly. iflhe orífice be ohflruéled

by thick. grumoul, or congealed blood, that impedimcnl may

be removed by wiping

with

(ponge dipt iD w

Ifrn

watel".

nUl that Ihe patient', arm ml y not become painflll or

Ianguid, by bolding it long eXlCnded, the furgeon O,r.uIJ

fuppon it by Ihe cubilus fUI" a li!tlc: while; and rhen gil'e

him a

fllCk,

01"

otht:r cylinrlr ic bndy,

turo rOllnd in 'Jis

hand, thal hy

the

contraélions or the: flexo r and extcnl'or

mufcles of Ihe finJ!C'r.s. lhe tourfc: of

(he

hlood may

:leee–

Je r~ tccl

tQ· ....."'I"ds Ihe: cubltus: \Vhich \Vil! tlill be (urthcr pro·

I!'!Oli!J.,

the p.ucnt urges a linle ,'o!untary cough.

\Vh, n there reems to be a fuflieient qu,n.;ty of bloocl

dlrch:tr~l'd,

lhe )igatu re muít thln be Immedialely

tllkt:n

off

(rolO ;:¡bove the dbow, ano the lkJo about the orífice muCl

aeXI

be geotly llroked or prdfcd together by Ihe two fore–

finS:t'f5

oi the

Icft_hand

by which O1eans the lips of Ihe di–

vidl·d

nin

are more e¡di ly compI"elfed and clored. But whilc

th..: furgt:on

dOlng thu with hís left haad, he tilkel ,he

fmalldl of

(he

t\Vo

comprdf:s,

il.od

;r.pplies it upoo' the ¡nci–

{jno \Vith his right_hand: bUI fo as lOJet what linle blood

m.l.y remflin l>ttvJiXt the urífi ce and Ihe vein, be di(charrrd,

befo l"e he impo(es the comprefs .

Ovrr

Ihe 6rfi or

fm;¡,1I

comprefs he Ihlluld impofe another thar is a little larg"r,

prd finr, thcm both gently on the onlice: with hi.s

¡e(t

thumb,

tdl

Ihe

b~od

Ige is l.lld acrofs.

¡'¡" 'ng 'p,l:cd )'our b,nd'ge, and dra\lln down ,he p'–

tient's flt:cve oYer his arm; he íhould be o,dered nOI

ure

il too eul y or víolently,

~e(ure

the órrfice is

weJl

c1ofed ,

which mighl eXcite

freO, hzmorrhagc , an inthmmalion,

rupp\Jr~tion ,

or other lHd

ti.

·cideol. And

the pallont

íhoulJ raiot aW:ly foon afler d:e operatioo,

may be

rtun

cODvelli~nt

\Ve' his noHnh with Hungary w;tter or .Iñe·

gn; aod tO

fprink.le

fome o( the lan, or elre cold water.

hís fíace; and, efpeclally

Cummer-time, to let in the (rcfh

and cool ¡ir, by opeolOg the windows,

éc.

Airo. if any

\Vine or cardi ..

w;uer,bc .lt hand, you may.give the laoguifh–

ing

paticct a Cmal! drauglu therear.

B LIED' NC

in ¡h,

rOOT.

BL ! tOINC

in the (oot is an operuion of very old fiand–

ing: ic ha\'ing beeo an ob(ervation made by the

mo(l

an–

cient phyrteians , th .. phlebotomy in tbis par! proved highl,

fervice.ble in mo(\ dirorders of the head aod brean, and for

3n obllrué1ion of

(he

menfirual and hzmorrhoidal flux, up'

whieh direh;rge. greatly depended the healthy n"e of

both fexes . For lhefe re.!.foos th:y lherefore denomioated

thoro . eins or the foot,

Saphma

. nd

C'phalica:

the I.n of

whlch extt'nds itfelf from,che inlernal ancle to the greal toe;

l nd the 6rl1, from lhe external

mal/rollu

to the {nuJler toe.s.

BUI

why one o(

Ihem

{hould be thoughc Or denominated

mnre c(·ph ... lic Ülfln the other. there

not the lean reafon

lo be offt'red; (¡nce blet:ding (rom eilher o( them has

alto–

gClher the vcry

I..

me eH'ell. T hereforc, ,he (urgeon (hould

alw ..

opcn thal whlch

)tet

f.ire n aoJ mofl confpicuous .

HUI ir the veins upon the

1JUlal arfiu,

or inUep of the foCK,

nfl l

well

appear,

may (hen be con,ecieot tO ope:n one:

of Ihufe at the ancle, or about the cal( or h¡¡m of ,he leg.

Nor

che phlt!bocomlfl

I¡able

inju re any o( ,he teodoos

in Ihefe laH

p1fts

as he

i.s upon lhe

m(lllfal/ul.

t'or the more e.lfy aod fuccefs(u l aperlion of (hefe . Ci05,

lhe patient mufl

r.rH

wafh both (eet we!! fnr fome lime

hOl w:uer ; Ih;H when the veins become fufllciendy curgid.

lhe furgeon nu y take hu choice of

th31

which prdents t'air–

en e¡ther in the right or

Idt

foot , without paying any Je ..

fe:rcnce lO Ihe diflinélion

riJ!hl ('\r le(( in .!.ny of Ihe fo rc–

m~ntioncd

dlforders. Ha\'log h'(cd upon (he flHlicular fool

and

velO . rour ligature

OluH

!JI::

.Ippl,cJ

about

( \\,'0

¡jn~ers

bre.1dih aboye

Ihe:

ancl~:

and Ihl!n lhe p.ltient O1Utt r\,qtrn

ir In (o (he wum w:tter, wh"e: the fu rgeon 'flkes uut .tn J pre–

P"I"CS his inllruml!lIt or )...

n~et

T hen kncehng dowo

0"\

('Ine

knce, Ihe furge-oll lakcs OUI the p.I,ic:nt 's tOOl froln the

U'Mnl

w.h.r.

'lo.1h...

ving

w'pc:d

dry

Wl1h

oapklll, places

U.'OIl

his olher

~nee,

or "Ife upun a b.J.!.rJ

Jaid

over

the

vclfd

hot