INFLAMMATION AND ABSCESSES, &c.

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eurgical purpose, it is best to bleed him in a recumbent posture.But when the person is strong and vigorous, there is little occasionfor this precaution, and a sitting posture is to be preferred, as themost convenient, both for the surgeon and patient.

At the bend of the arm, there are several veins in which a punc-ture may be made, viz. the basilic, cephalic, median basilic, andmedian cephalic. The median basilic vein being usually the larg-est and most conspicuous, is that in which the operation is mostlyperformed ; but it should never be forgotten, that it is under thisvessel that the brachial artery runs, with the mere intervention ofthe thin aponeurotic sheath, sent oft* by the biceps muscle. In le-ry thin persons, indeed, the medial basilic vein lies almost closeto the artery, and nothing is then more easy than to transfix thefirst of these vessels and wound the last.

In fat subjects, the large veins at the bend of the arm are some-times totally imperceptible, notwithstanding the ñllet is tightly ap-plied, the limb is put in warm water, and every thing done to makethose vessels as turgidi as possible. Under these circumstances, ifthe surgeon has not had much experience in the practice of vene-section, he will do well to be content with opening one of the veinsof the back of the hand, after putting the member for some time inwarm water, and applying a ligature round the wrist.

In children, a sufficient quantity of blood cannot always be ob-tained by venesection, and, in this event, the free application ofleeches, and, occasionally, the puncture of the temporal artery,are the only effectual methods.

One of the most common ill consequences of bleeding in the armis a thrombus, or ecchymosis, that is, a small tumour around theorifice, and occasioned by the blood insinuating itself into the ad-joining cellular substance, at the time this fluid is escaping fromthe vein. Changing the posture of the arm will frequently hinderthe thrombus from increasing in size, so as to obstruct the evacua-tion of blood. The best applications for promoting the abst rptionof these tumours, are those containing spirit, vinegar, or i uriateof ammonia. Compresses wetted with any lotion of this sort, i,.aybe advantageously put on the swelling, and confined there with aslack bandage.

The integuments and subjacent cellular substance, the absorb-ents, the vein, &.c. are all liable to inflammation, in consequenceof bleeding, a nerve also may be wounded, all requiring propereurgical treatment.

Topical Blood-letting.

This is performed either by means of a scarificator and cupping-glass, or leeches, or by dividing the visibly distended vessels witha lancet, as is frequently done in cases of inflammation of the eye.

Inflammations and Abscesses.

From whatever cause inflammation proceeds, it must terminateeither by dispersion, suppuration, or gangrene. Though it is im-possible to foretel with certainty in which of these ways any par-ticular inflammation will terminate, yet a probable conjecture may