The principles of surgery / by James Syme.

  • Syme, James, 1799-1870.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: The principles of surgery / by James Syme. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    blood to escape. When the patient is fat, or the vessel small, the surgeon, not being able to see the veins, must feel for them ; and then the one already mentioned, the median basilic, is gene- rally recognised most easUy, both from its large size and regular situation, on the inner side of the tendinous attachment of the biceps to the fascia of the fore-arm. The humeral artery lies under the vein at this point, but runs no danger of being wounded, unless the lancet is used with undue force. The only artery that can be injured in a natural distribution of the vessels is the humeral; but the arteries of the fore-arm frequently take a superficial course, which makes them assume the appearance of veins ; whence it is always proper to ascertain, before intro- ducing the lancet, that the vessel is really a vein by its want of pulsation. The cutaneous nerves are so small and intimately connected with the veins, that they cannot be avoided by any precaution; and there is reason to believe, from the acute pain occasionally complained of, that they are not unfrequently divided; but bad consequences seldom if ever result, either from this source or the alleged pricldng of tendons, which was formerly much dreaded. When any local inconvenience results from the operation, it is now thought to depend upon inflamma- tion of the skin, cellular substance, or vein, owing to peculiar irritability of the patient's constitution, or the manner in which the surgeon has inflicted or dressed the wound. These accidents will be best avoided by performing the operation as has been de- scribed above; and when they do occur, ought to be treated according to the principles which will be explained hereafter, in connection with the textures liable to injury. The external jugular may be rendered sufficiently tense for being opened, by pressing on it with the thumb a little above the clavicle. The lancet may then be introduced in the same way as has been recommended; and if the incision be made in the direction of the sterno-mastoid muscle, it will not only insure the division of the superjacent fibres of the platysma myoides, but also have the proper degree of obliquity in respect to the coats of the vein. The edge of the cup, which is to