with the other end in a knot on the outside of the arm above the elbow.

• In this operation you must obferve,

(1.) When there are many cicatrices in the fkin from previous bleedings, to open the vein immediately below the laft, if nothing forbid.

(2.) That the skin and vein be not distorted from their natural fituations in applying the ligature, or by preffing the thumb at the time of incifion; otherwife the orifice of the skin and that of the vein will not correspond, which if it should happen, they are to be aflifted by moving the arm or skin at difcretion, or by enlarging the orifice.

(3.) That a tolerable large orifice is always preferable to a small one, as the laft, especially when the incifion is near a valve, is commonly attended with a thrombus or grumous concretion, or else permits only the finer parts of the blood to escape.

(4.) That if the vein lies deep, it must be opened by a lancet with a broad blade, or an obtufe-angled point; and though the first kind of lancet, that is, the fmall or fpearpointed with a fhort blade, always bleeds eafieft in a skilful, hand, yet the broader kind is fafeft for beginners, to avoid injuring the large artery and brachial nerve, which lie under the bafilic vein, and the tendon or its aponeurofis of the biceps muscle which lie under the median.

The principal accidents which may happen to an ignorant or careless furgeon in the opening of a vein, are,

(1.) An ecchymofis, or extravafation of the blood from the vein into the cellular membrane betwixt the flesh and fkin, either from the vein being divided, or from a too early and violent exercife of the arm before the orifice is closed; in which cafe, if a difcuffion cannot be procured, it must be brought to fuppuration, as before defcribed in tumors.

(2.) The puncture of a nerve or tendon is inftantly attended with most excruciating pain, foon followed with an inflammation and fwelling of the limb, which often ends in convulfions, a gangrene, or death, if not timely relieved: all which must be prevented, if poflible, by repeated bleedings in the other arm, by cooling purges and clyfters, with a di luent antiphlogiftic diet, and a poultice of bread and milk, with olive oil, applied warm over the orifice, on a pledget of the bafilic. flav.

A puncture or wound of an artery, which will plainly manifeft itself by the blood flowing out by ftarts, with great impetuofity, of a very florid colour, and which will probably produce an aneurifm, or a gangrene, and death, if not VOL. XXIX. March, 1770.

timely

timely remedied by the application of a bit of lead, of a fuitable shape, folded up in a piece of clean linen, and retained as a comprefs on the artery by a ftrict bandage; or rather, a compreffion is to be made upon the artery by an inftrument for that purpose: after this a long comprefs is to be fecured upon the humeral artery by a pretty ftrict fpiral 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 punc ture of a nerve or tendon, by which means a true or spurious aneurism, and their feveral caufes, may often be prevented.

When you are to bleed in the foot or hand, you must observe, 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 fome grown perfons, 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 fufficient quantity is discharged.

In the fame manner alfo are the faphena and cephalic veins in the foot to be opened, after bathing them in warm water, and tying the ligature tight above the ancle, dreffing the orifice as before, and retaining the comprefs by the bandage defcribed 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 affiftant: then preffing your thumb upon the vein which appears faireft (on the disordered fide, if poffible) make an orifice agreeable to what was before directed, applying a bit of plafter, comprefs, 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 fo commonly in practice as it deferves. Sometimes a lefs confiderable vein is opened nearer the inflamed or difordered part itself, as in those which run down on each fide of the nofe, in the canthi majores or inner corners of the eyes for an ophthalmia, in the veins under the tongue for a quinfy, the vena dorfalis penis in a priapilm, &c.

Bleeding in the foot is juftly reckoned to make a greater revulfion than that in the arm, in diforders of the head, thorax, and abdominal vifcera, efpecially in a fuppreflion of the menftrual or hæmorrhoidal flux. If the veins in the foot are

not

not fufficiently confpicuous, open one at the ancle, or near the calf or ham, &c.'

The Pharmacopoeia 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 interfperfed the obfervations of other authors who have wrote the beft on the feveral fubjects; and what reflects great honour upon his ingenuity, he never affects to conceal fuch information, though his own experience appears fufficiently great to be fully fatisfactory. As a specimen of his manner in this part of the work, we shall present our readers with the account of poifons.

All the three kingdoms have poisons peculiar to themfelves, but the animal kingdom affords the moft fubtile, which are communicated by the bite of mad or venemous beafts. The mineral kingdom produces arfenicals and mercurials; the vegetable, herbs and plants, or their parts, of a moft acrid, noxious, and deleterious quality, fuch as the most violent cathartics and narcotics, &c.

Every fort of poifon feems to have an effect peculiar to itfelf; thus mercury attacks the fauces and their glands, pro- . ducing ulcerations therein; arfenic occafions the moft cruel torments, convulfions, and mortification of the coats of the inteftines; the feeds of datura, a kind of ftramonium, induce madness or abfolute ftupidity; hyofciamus caufes a ftupor, and so troubles the imagination, that the perfon affected believes he fees dæmons and fpe&tres; opium brings on fleepiness, and a torpor of the mind. Sharp draftic purges inflame the intestines. The bite of a mad dog occafions the dread of water. The venom induced by the fting of a tarantula produces wonderful effects; for the patient is delighted with mufical inftruments, and, when he hears their found, immediately falls a capering, ufing many antic gefticulations.

The fting of a fcorpion produces a fudden and exceeding cold fweat. Litharge unwarily taken caufes a convulfive colic, with an obftinate coftiveness. The berries of deadly night-fhade produce madness, rage, or folly; as do alfo the roots of cicuta terreftris. The bites of fpiders, fcorpions, and vipers are most pernicious in hot countries.

The fymptoms which follow the bite of a viper, are a fharp pricking pain in the wounded part: a tumour which is first red, and afterwards livid, fenfibly extending itself to the neighbouring parts; the fkin frets and breaks out into little bladders; fome time after a remarkable faintnefs fupervenes, with a quick, weak, and fometimes an intermitting pulfe, a palpitation of the heart, a ftupefaction of the fenfes,

an anxiety of the præcordia, great fickness at the ftomach, with bilious vomiting, dulnefs of fight, fometimes pains about the navel, or the region of the liver, difficult breathing, hiccoughs, tremblings, convulfions, cold fweats, coldness of the extremities; after which death closes the scene, unless prevented by timely remedies, or the vigour of the conftitu tion.

If the patient furvives,' a tumour with inflammation continues for fome time. Sometimes a fanies flows from the wound, and puftules appear, like the herpes excedens; the skin becomes yellow, as if the patient had the jaundice.

The cure confifts in immediately chafing the part well with warm fallad oil for fome time, and internally giving cordials and diaphoretics, with anodines; fuch as the hauft, diaphoretic. (6) (in Phar. Mar.) to promote a diaphorefis without heating, which should be supported with proper diluents, and the part kept conftantly wet with the warm oil, till the fymptoms, tumour, and inflammation cease.

The bite of a rattle fnake, hitherto looked upon as a moft terrible accident, may now be cured in a fimple 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 fettled upon him during his life by the general aflembly of Carolina; which I mention as being necessary to eftablish the credit of the receipt.

• Take of the roots of plantane and horehound (in the fummer the roots and branches together) a fufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give as foon as poflible one large spoonful; if the patient be fwelled you muft 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 moiftened with a little water.

To the wound may be applied a leaf of good tobacco moistened with rum.

Etius obferves, that there are three kinds of afps, viz. the terreftrial, the chelidonia (which are found on the banks of the Nile) and ptyades; the terreftrial are fometimes five cubits in length, and fometimes greenifh: the ptyades are longer than the terreftrial, and of an afh-colour mixed with green and gold.

The bite of an afp 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 exafperated. It is attended with a ftupor, palenefs, coldness of the forehead, continual yawning, twinkling of the eyes, inclination of the

neck,

neck, laffitude of the body, and a profound fleep with convulfions. 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, fwelling of the face, and deafnefs; death after a bite of this kind comes on more flowly.

• Drinking plenty of the fharpeft vinegar is faid to be a cure. Celfus gives us an inftance 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 thefe weave any webs like the domeftic 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 fhall fay nothing further on poifons of this kind.

Heifter fays, the ftings of wafps and bees, &c. may be cured with vinegar alone, or mixed with ther. androm. or bol, armen. Some rub the part well with the pulp of a four apple; others ufe a continual application of the infufion of elder-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 alfo good; if the fting is left behind, it should first of all (if poffible) be taken out.

When stung in the throat by fwallowing a wafp, or any other infect, 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 firft) ordering to fwallow it leifurely; as the fymptoms abate, it may be taken feldomer, but continued for fome time in intervals; order the patient to forbear fpeaking, and to compofe himself to reft.

The toad, fays Allen, is full of venom, and the very centre and repofitory of terreftrial poifons: if they have no teeth, yet their gums are hard and rough, and by a powerful adhesion fo operate upon the part as to inftil their venom therein. The virulence of this animal feems to confift in its excrements, particularly in a fharp, cauftic urine, impregnated with a volatile falt; for when they are dead they are faid to be not at all venemous; they discharge their venom on herbs (particularly ftrawberries) by piffing, fpitting, and vomiting; this is not only pernicious by getting into the body, but by being fprinkled on the fkin, unlefs washed off immediately with urine. and falt.

When a perfon is infected, his fkin turns yellow, his body fwells univerfally, his lips and tongue grow black, and a stammering fupervenes; he is feized with an afthmatic fhortness of

0 3

breath,