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838. Minor Operations.

839. Bleeding is sometimes necessary at once in certain accidents, such as concussion, and therefore it is well to know how to do this. First of all, bind up the arm above the elbow with a piece of bandage or a handkerchief pretty firmly, then place your finger over one of the veins at the back of the arm, and feel if there is any pulsation; if there is, try another vein, and if it does not pulsate or beat, choose that one. Now rub the arm from the wrist towards the elbow, place the left thumb upon the vein, and hold the lancet as you would a pen, and nearly at right angles to the vein, taking care to prevent its going in too far, by keeping the thumb near to the point, and resting the hand upon the little finger. Now place the point of the lancet on the vein, push it suddenly inwards, depress the elbow, and raise the hand upwards and outwards, so as to cut obliquely across the vein. When sufficient blood is drawn off, which is known by feeling the pulse at the wrist, and near the thumb, bandage the arm. If the pulse feel like a piece of cord, more blood should be taken away, but if it is soft, and can be easily pressed, the bleeding should be stopped. When you bandage the arm, place a piece of lint over the opening made by the lancet, and pass a bandage lightly but firmly around the arm, so as to cross it over the bend of the elbow, in form of a figure 8.

840. Dry Cupping is performed by throwing a piece of paper dipped into spirit of wine, and ignited, into a wine-glass, and placing it over the part, such as the neck, temples, &c. It thus draws the flesh into the glass, and causes a determination of blood to the part, which is useful in headache, and many other complaints. This is an excellent method of extracting the poison from wounds made by adders, mad dogs, fish &c.

841. Ordinary Cupping is performed the same as dry cupping, with this exception, that the part is scarified or scratched with a lancet, so as to cause the blood to flow; or by the application of a scarificator, which makes by one action from seven to twenty-one light superficial cuts. Then the glass is placed over it again with the lighted paper in it, and when sufficient blood has been taken away, the parts are then sponged, and a piece of sticking plaster placed over them.

842. Leeches and their Application.--The leech used for medical purposes is called the hirudo medicinalis, to distinguish it from other variations, such as the horse-leech and the Lisbon leech. It varies from two to four inches in length, and is of a blackish brown colour, marked on the back with six yellow spots, and edged with a yellow line on each side. Formerly leeches were supplied by Lincolnshire, Yorkshire, and other fenny counties, but latterly most of the leeches are procured from France, where they are now becoming scarce.

843. When Leeches are Applied to a part, it should be thoroughly freed from down or hair by shaving, and all liniments, &c., carefully and effectually cleaned away by washing. If the leech is hungry it will soon bite, but sometimes great difficulty is experienced in getting them to fasten. When this is the case, roll the leech into a little porter, or moisten the surface with a little blood, or milk, or sugar and water. Leeches may be applied by holding them over the part with a piece of linen cloth, or by means of an inverted glass, under which they must be placed.

844. When applied to the Gums, care should be taken to use a leech glass, as they are apt to creep down the patient's throat: a large swan's quill will answer the purpose of a leech glass. When leeches are gorged they will drop off themselves; never tear them off from a person, but just dip the point of a moistened finger into some salt and touch them with it.

845. Leeches are supposed to abstract about two drachms of blood, or six leeches draw about an ounce; but this is independent of the bleeding after they have come off, and more blood generally flows then than during the time they are sucking. The total amount of blood drawn and subsequently lost by each leech-bite, is nearly half an ounce.

846. After Leeches come away, encourage the bleeding by flannels dipped in hot water and wrung out dry, and then apply a warm spongio-piline poultice. If the bleeding is not to be encouraged, cover the bites with a rag dipped in olive oil, or spread with spermaceti ointment, having previously sponged the parts clean.

847. When Bleeding continues from leech-bites, and it is desirable to stop it, apply pressure with the fingers over the part, or dip a rag in a strong solution of alum and lay over them, or use the tincture of sesquichloride of iron, or apply a leaf of matico to them, placing the under surface of the leaf next to the skin, or touch each bite with a finely-pointed piece of lunar caustic, or lay a piece of lint soaked in the extract of lead of the bites; and if all these tried in succession fail, pass a fine needle through a fold of the skin so as to include the bite, and twist a piece of thread round it. Be sure never to allow any one to go to sleep with leech-bites bleeding, without watching them carefully; and never apply too many to children; or place them where their bites can be compressed if necessary. In other words, never apply leeches to children except over a bone.

848. After Leeches have been used they should be placed in water containing sixteen per cent. of salt, which facilitates the removal of the blood they contain; and they should afterwards be placed one by one in warm water, and the blood forced out by gentle pressure. The leeches should then be thrown into fresh water, which is to be renewed every twenty-four hours: they may then be re-applied after interval of eight or ten days, and be disgorged a second time. The best plan, however, is to empty the leech by drawing the thumb and forefinger of the right hand along its body from the tail to the mouth, the leech being firmly held at the sucker extremity by the fingers of the left hand. By this means, with a few minutes' rest between each application, the same leech may be used four or five times in succession.

849. If a Leech be accidentally swallowed, or by any means should get into the body, employ an emetic, or enema of salt and water.

850. Scarification is useful in severe contusions, and inflammation of parts. It is performed by scratching or slightly cutting through the skin with a lancet, holding the lancet as you would a pen when you are ruling lines on paper.

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