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with the other end in a knot on the outside of the arm above the elbow.
• In this operation yo:1 mult observe,
! (1.) When there are many cicatrices in the skin from previous bleedings, to open the vein immediately below the last, if nothing forbid.
. (2.) That the skin and vein be not distorted from their natural situations in applying the ligature, or by presling the thumb at the time of incision; otherwise the orifice of the skin and that of the vein will not correlpond, which if it should happen, they are to be assisted by moving the arm or skin.at discretion, or by enlarging the orifice.
• (3.) That a tolerable large orifice is always preferable to a small one, as the last, especially when the incision is near a valve, is commonly attended with a thrombus or grumousconcretion, or else permits only the finer parts of the blood to efcape.
(4.) That if the vein lies deep, it must be opened by a lancet with a broad blade, or an obtuse-angled point; and though the first kind of lancet, that is, the small or spearpointed with a short blade, always bleeds easiest in a skillul, hand, yet the broader kind is safest for beginners, to avoid injuring the large artery and brachial nerve, which lie under the basilic vein, and the tendon or its aponeurosis of the biceps muscle which lie under the median.
· The principal accidents which may happen to an ignorant or careless surgeon in the opening of a vein, are,
(1.) An ecchymosis, or extravasation of the blood from the vein into the cellular membrane betwixt the flesh and skin, either from the vein being divided, or from a too early and violent exercise of the arm before the orifice is closed ; in which case, if a discussion cannot be procured, it must be brought to suppuration, as before described in tumors.
(2.) The puncture of a nerve or tendon is instantly attended with most excruciating pain, foon followed with an in. flammation and lwelling of the limb, which often ends in convulsions, a gangrene, or death, if not timely relieved: all which must be prevented, if pollible, by repeated bleedings in the other arm, by cooling purges and clyfters, with a di. luent antiphlogistic diet, and a poultice of bread and milk, with olive oil, applied warm over the orifice, on a pledget of the basilic, flav.
• A puncture or wound of an artery, which will plainly manifest itself by the blood flowing out by starts, with great impetuofity, of a very florid colour, and which will probably produce an aneurism, or a gangrene, and death, if nog VOL. XXIX. Alarcb, 1770.
timely remedied by the application of a bit of lead, of a suite able shape, folded up in a piece of clean linen, and retained as a compress on the artery by a strict bandage ; or rather, a compression is to be made upon the artery by an instrument for that purpose : after this a long compress is to be secured upon the humeral artery by a pretty strict spiral bandage, to break off the impetus of the blood from the part affected ; and the rest of the treatment may be conducted as for the puncture of a nerve or tendon, by which means a true or spurious aneurilm, and their several causes, may often be prevented.
• When you are to bleed in the foot or hand, you must ob. serve, that in the hand there are two veins ; the splenica, running on the back towards the little finger, and the cephalica, betwixt the thumb 'and fore finger, which in children and some grown persons, where the other veins are not confpicuous, may be opened to advantage. After having first bathed the hand well in warm water, and fixed a ligature upon the carpus, an orifice is to be made by the lancet, as before directed ; and if the blood does not run freely, the hand is to be kept in warm water till a sufficient quantity is · discharged.
"In the same manner also are the saphena and cephalic veins in the foot to be opened, after bathing them in warm water, and tying the ligature tight above the ancle, dressing the orifice as before, and retaining the compress by the bandage described for a luxation of the ancle.
" When you are to bleed in the jugular or occipital vein, it must be first rendered turgid by a neckcloth, or the common ligature, drawn and held tight about the lower part of the neck by the patient or an assistant: then preiling your thumb upon the vein which appears fairest (on the disordered fide, if possible) make an orifice agreeable to what was before directed, applying a bit of plaster, compress, and a circular bandage, after the operation is finished.
• Bleeding here is preferred for most disorders of the head, brain, eyes, &c. though it is not so commonly in practice as it deserves. Sometimes a less considerable vein is opened nearer the infamed or disordered part itself, as in those which run down on each side of the nose, in the canthi majores or inner corners of the eyes for an ophthalmia, in the veins under the tongue for a quinsy, the vena dorsalis penis in a priapilm, &c.
Bleeding in the foot is justly reckoned to make a greater revulsion than that in the arm, in disorders of the head, tho. rax, and abdominal viscera, especially in a suppreflion of the menstrual or hæmorrhoidal flux. If the veins in the foot are
not sufficiently conspicuous, open one at the .ancle, or near the calf or ham, &c.'
The Pharmacopæia Marina, at the end of this volume, contains many excellent forms of extemporaneous prescription.
In the second volume, which treats of the Practice of Phyfic, Mr. Northcote has liberally interspersed the observations of other authors who have wrote the best on the several subjeas; and what reflects great honour upon his ingenuity, he never affects to conceal such information, though his own experience appears sufficiently great to be fully satisfactory. As a specimen of his manner in this part of the work, we shall present our readers with the account of poisons.
• All the three kingdoms have poisons peculiar to them. selves, but the animal kingdom affords the most subtile, which are communicated by the bite of mad or venemous beasts. The mineral kingdom produces arsenicals and mercurials; the vegetable, herbs and plants, or their parts, of a most acrid, noxious, and deleterious quality, such as the most violent ca. thartics and narcotics, &c.
• Every sort of poison seems to have an effect peculiar to itself; thus mercury attacks the fauces and their glands, pro- . ducing ulcerations therein ; arsenic occasions the most cruel torments, convulsions, and mortification of the coats of the intestines; the seeds of datura, a kind of stramonium, induce madness or absolute stupidity ; hyosciamus causes a stupor, and so troubles the imagination, that the person affected believes he sees dæmons and spectres ; opium brings on sleepiness, and a torpor of the mind. Sharp drastic purges inflame the intestines. The bite of a mad dog occasions the dread of water. The venom induced by the iting of a tarantula produces wonderful effects ; for the patient is delighted with musical instruments, and, when he hears their sound, immediately falls a capering, using many antic gesticulations. :The sting of a scorpion produces a sudden and exceeding cold sweat. Litharge unwarily taken causes a convulsive colic, with an obstinate costiveness. The berries of deadly night-fhade produce madness, rage, or folly ; as do also the roots of cicuta terrestris. The bites of spiders, scorpions, and vipers are most pernicious in hot countries.
The symptoms which follow the bite of a viper, are a sharp pricking pain in the wounded part: a tumour which is first red, and afterwards livid, sensibly extending itself to the neighbouring parts; the skin frets and breaks out into little bladders; some time after a remarkable faintnefs fupervenes, with a quick, weak, and sometiines an intermitting pulse, a palpitation of the heart, a ftupefaction of the senses, O 2
an anxiety of the præcordia, great sickness at the stomach, with bilious vomiting, dulness of sight, sometimes pains about' the navel, or the region of the liver, difficult breathing, hiccoughs, tremblings, convulsions, cold sweats, coldness of the extremities; after which death closes the scene, unless prevented by timely remedies, or the vigour of the constitu: tion. . If the patient survives,' a tumour with inflammation continues for some time. Sometimes a sanies flows from the wound, and puftules appear, like the herpes excedens ; the skin becoines yellow, as if the patient had the jaundice.
• The cure consists in immediately chafing the part well with warm sallad oil for some time, and internally giving cor. dials and diaphoretics, with anodines; such as the hauft, dia. phoretic. (6) (in Phar. Mar.) to promote a diaphoresis without heating, which should be supported with proper diluents, and the part kept constantly wet with the warm oil, till the symptoms, tumour, and inflammation cease.
The bite of a rattle snake, hitherto looked upon as a most terrible accident, may now be cured in a simple easy manner. It is the invention of a negro, for the discovery of which he had his freedom purchased, and one hundred pounds per annum settled upon him during his life by the general allembly of Carolina ; which I mention as being necessary to establish the credit of the receipt. .
• Take of the roots of plantane and horehound in the summer the roots and branches together) a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give as soon as possible one large spoonful ; if the patient be fwelled you must force it down his throat : this generally will cure ; but if he finds no relief in an hour after, you may give another spoonful, which never fails. If the roots are dried, they must be moistened with a little water.
• To the wound may be applied a leaf of good tobacco moistened with rum.
• Ælius obferves, that there are three kinds of asps, viz. the terresorial, the chelidoniæ (which are found on the banks of the Nile) and piyades; the terrestrial are sometimes five cubits in length, and sometimes greenish : the ptyades are longer than the terrestrial, and of an afh-colour mixed with green and gold. . " The bite of an asp is like the prick of a needle : from a male it is double, from a female quadruple. Nothing diftils from the wound unless the animal is much exasperated. It is atienced with a stupor, paleness, coldness of the forehead, continual yawning, twinkling of the eyes, inclination of the
neck, laffitude of the body, and a profound sleep with con. vulsions. The bite of the chelidonia produces immediate death; that of the terrestrial kills in three hours; that of the ptyas produces dimness of fight, pain at the heart, swelling of the face, and deafness; death after a bite of this kind comes on more slowly.
• Drinking plenty of the sharpest. vinegar is said to be a cure. Celsus gives us an instance of a boy cured by drinking of vinegar, when there was nothing else at hand. ; 'Spiders are of two forts, the noxious and the harmless;
the noxious are called phalangia ; none of these weave any · webs like the domestic or harmless fort. Of the former, the
tarantula is most often mentioned, and where that species abounds, the cure of its bite is well known; therefore I shall say nothing further on poisons of this kind. .Heister says, the stings of wasps and bees, &c. may be cured with vinegar alone, or mixed with ther. androin. or bol, armen. Some rub the part well with the pulp of a four apple ; others use a continual application of the infusion of el.
der flowers, mixed with a little theriac, androm. and cover the ..part with a poultice of bread and milk, with a little mel.
Britan, et ther, andr, mixed; oil applied immediately is also good ; if the sting is left behind, it should first of all (if poffible) be taken out.
" When stung in the throat by swallowing a wasp, or any other insect, beat up a little honey and oil together, with a little vinegar, till they are well mixed; then give a spoonful of it every minute (at first) ordering to swallow it leisurely ; as the symptoms abate, it may be taken seldomer, but continued for some time in intervals; order the patient to forbear speaking, and to compose himself to rest.
• The toad, says Allen, is full of venom, and the very centre and repository of terrestrial poisons : if they have no teeth, yet their gums are hard and rough, and by a powerful adhesion so operate upon the part as to instil their venom therein. The virulence of this animal seems to consist in its excrements, particularly in a sharp, caustic urine, impregnated with a vo. Jatile falt; for when they are dead they are said to be not at all venemous; they discharge their venom on herbs (particularly strawberries) by pissing, spitting, and vomiting ; this is not only pernicious by getting into the body, but by being sprinkled on the skin, unless washed off immediately with urine and salt.
"When a person is infected, his skin turns yellow, his body swells universally, his lips and tongue grow black, and a stammering fupervenes; he is seized with an asthmatic shortness of 03