In the inflammatory fever, when the head is more affected than any other part of the body, the exter nal jugular vein, the temporal, or the occipital ar tery, should be opened, as the relief is greater the nearer the blood-vessel is to the affected organ ; again, as arterial blood affects the system more quickly and for a longer period than venous, the temporal or occipital artery ought to be preferred to the external jugular vein, as in general one half the quantity of arterial, compared with venous blood, produces fainting.
The operation of opening an artery is termed Ar teriotomy, and is now almost exclusively confined to the temporal, in consequence of its being more easily reached, although the occipital, which was preferred by the ancients, would be the most bene ficial, from its direct inosculation with the vertebral artery. In the days of Galen the arteries of the hand were frequently opened. In the Medico-Chir. Trans. of Edinburgh, vol. i., a case is mentioned, where the radial artery was opened by Mr. Mind, surgeon in India. When the temporal artery is to be opened, the patient should be in the horizontal position, with his head resting on a pillow ; the operator then feeling the course of the trunk of the artery, as it runs over the zygoma, or one of its branches as it ascends along the temple, places the fore-and middle fingers of his left hand on the ves sel, in order to render it steady, the one above or distad, the other below or proximad, of the artery, while with his right hand he makes an oblique in cision, about half an inch in length, through the integuments down to the artery, with a lancet, cut ting as if it were a scalpel. When the artery is distinctly seen traversing this little wound, the sur geon is to make a similar oblique incision of the vessel, cutting it in a contrary direction, or picking it from below upwards, as if he were opening a vein of the arm. Sec Plate DXVII. Fig. 6. When the necessary quantity of blood has been taken, the lips of the wound are to be approximated, a firm compress made of a roller of calico, about one inch in diameter, as delineated in Fig. 12, applied over it, and a double-headed roller to encircle the head, crossing as often as possible over the. compress. See Fig. 8. The wound should be dressed on the third day, either with adhesive plaster, or simple cerate, according to its appearance, and the com press and bandage reapplied. Afterwards it ought to be dressed daily, and the compress and bandage worn for at least a month, as aneurism is very lia ble to supervene to this little operation. Arteri
otomy is preferred to phlebotomy, in inflammation of the brain or eye, especially Iritis.
The opening of a vein is termed Phlebotomy, from a vein, and TV-tvw to cut, also venesection or bleeding. Venesection is commonly applied to blood-letting at the bend of the arm, although we sometimes select the external jugular, or one of the veins on the back of the hand, foot, or ankle. It is sometimes performed on the veins of the scrotum ; it has been done in the veins under the tongue and on the forehead, but these last are now abandoned. The external jugular is preferred in apoplexy and croup ; the veins at the bend of the arm, in general inflammatory diseases and after accidents ; those on the hack of the hand, foot, and ankle, in very fat people, when a vein at the bend of the arm or external jugular can neither be seen nor felt. In many individuals, the veins at the bend or the arm can only be felt ; and in such cases the surgeon should be experienced, and most careful, as a nerve, the artery, or the tendon of the biceps, might be mistaken.
When the hand or foot is selected, it should be immersed in hot water, and retained there during the flow of the blood ; and the same should be done when the scrotum is the part affected, arid the pa tient may stand before the lire, as he should be in the erect position.
The manner of opening the external jugular vein, is to place the head of the patient on a pillow, while his body reclines in the horizontal posture ; then press with the thumb of the left hand on the vein after it has crossed the sterno-mastoid muscle, and when it becomes turgid, place the fore and middle fingers of the same hand above and below the point to be wounded, which should be in the region of the sterno-mastoid muscle ; then with the lancet in the right hand an incision is to be made oblique ly across the integuments from above downwards, using the lancet as a scalpel, and when the vein is distinctly seen, it is to be cut upwards as at the bend of the arm. See Fig. 7, Plate DXVII. Whenever the blood has begun to flow, the middle fingers of the left hand are to be removed, but the thumb is to remain until the quantity required has been ab stracted, and the wound closed with adhesive plas ter, as air may enter in by the wound of the vein and prove fatal ; a case of which is detailed in the Lancet, No. 259. No compress or bandage is to be used, for it would check the cutaneous venous circulation of the head.