3. Pledget of lint.
4. Dish.
5. Staff.
In opening a vein at the bend of the elbow, the median basilic is selected, simply because it is usually the largest, but any branch that is superficial, and well filled with blood, may be opened.
The patient should sit or stand, in which positions, syncope, one of the objects of bleeding, is attained by the abstraction of a less amount of blood than in the horizontal posture.
The surgeon places a graduated bleeding dish on a chair or stool within his reach, and a pledget of lint in his waistcoat pocket; he next gives the patient a heavy book, or staff to grasp in his hand. The arm being bare to the shoulder, a tape, ¾ inch broad and 1¼ yard long, is tied round the arm tight enough to impede the venous, but not the arterial flow.
The surgeon standing opposite his patient and grasping the arm to be bled with his left hand, so that his thumb controls and steadies the swollen vein, takes his lancet between the right forefinger and thumb; then going through skin and vein at one stroke, carries the lancet upwards for about ¼ inch along the vein. The puncture of the lancet should be quite vertical, and the extraction also made quite vertically, that the slit in the vein may correspond to the slit in the skin.
Fig. 17.—Adjusting the tape after bleeding.
This being done, the operator lays aside his lancet, and takes up the dish, holding it so that the blood shall flow into it: when the dish is placed, he lifts his left thumb from the vein cautiously or the sudden spirt of blood will fall outside the dish and be lost. When the desired amount is drawn, the operator compresses the vein again with the left thumb, and setting down the dish, puts the pledget of lint over the wound. He keeps the pledget in place with his left thumb, while he releases the tape round the arm and places its middle obliquely across the pledget. His left thumb presses the pledget on the wound, while the right hand takes the end of the tape which is farthest from his left, and passes it under the forearm below the elbow to his left fingers, which grasp it tightly. He then takes the other end with his right hand (see fig. 17), and bringing it round the arm above the elbow, carries it across the pledget: as he does this, he replaces his left thumb on the compress with his right forefinger, which he keeps there while he brings up the end of the tape he has already in his left fingers, and throws it over the arm above his right forefinger, then passing his left hand below the right forefinger, he catches the same end of the tape again and draws it back. The two ends thus locked in a loop over the compress, are secured by tying them in a bow outside the elbow and the operation is finished (see fig. 18).