Bloodletting, Or Phlebotomy (Gr. a vein, and to cut), the act of opening a vein for the purpose of withdrawing blood, as a means of relief in certain cases of diseased action in the organism. Bloodletting is usually performed at the bend of the arm, because the superficial veins are large in that locality, and more distinctly seen than anywhere else. Before using the lancet the surgeon ascertains the position of the artery at the bend of the arm; it is commonly felt pulsating nearly under the largest vein. This vein must be avoided, because of the danger of wounding the artery by passing the lancet too deeply. The vein next in size, but not so near the artery, is therefore selected. A bandage about two fingers in breadth and a yard in length is tied firmly round the arm, about an inch above the place where the opening is to be made. This will cause the veins to rise; but care must be taken not to tie the bandage so tightly that the pulse cannot be felt at the wrist. The surgeon then grasps the elbow with his left hand, placing his thumb firmly upon the vein, a little below the place where he intends making the puncture, to keep it in its place, and prevent it from rolling under the skin during the operation. The lancet is then passed obliquely into the vein.
The flow of blood is facilitated by keeping the hand and wrist in motion. When a sufficient quantity has been discharged, the bandage is removed from the arm above the puncture; the surgeon puts his thumb upon the wound to stop the bleeding, and with the other hand washes the blood from the arm. The lips of the wound are then placed in con-: tact; a small compress of old linen is placed over it, and secured by a bandage passed round the elbow in the form of the figure 8. The crossing of the bandage should be immediately over the compress. If blood should make its way through the linen some time after the arm has been bound up, the bandage must be made more tight, and slackened somewhat after the bleeding has ceased. The bandage is retained two or three days, and the arm is kept in a sling, for rest, at least 24 hours. In fat people it is sometimes very difficult, or perhaps impossible, to render the superficial veins of the arm visible; in such cases blood may be drawn from the ankle. A bandage is applied round the leg about two inches above the ankle; the foot is immersed some time in warm water, to make the veins rise; the largest vein either on the inside or the outside of the ankle is then opened, and the foot is again plunged into warm water, or the blood would not run freely.
Bleeding at the wrist is also resorted to, when the veins at the bend of the arm are too small or otherwise difficult to operate upon; the cephalic vein of the thumb or the back and outer side of the wrist is selected in that case. Bleeding at the neck is also practised at times. In this case the operation is performed on the external jugular vein, at either side of the neck. The vein runs in an oblique direction, and the incision is made at the lower part of the neck, because the vein is there more prominent, and higher up it is surrounded by a network of nerves which it would be dangerous to wound. In addition to the usual materials, a card is required in this operation to form a channel for the blood. Two or three pledgets are placed, one upon the other, on the jugular vein, at its lowest part, just above the collar bone. These are maintained in place by a ligature, the centre of which is placed directly upon them, while the two ends are carried down, the one forward, the other backward, to the opposite armpit, where they are tied in a single bow. The vein then swells, and should be fixed by two fingers of the left hand.
Beneath the skin of the neck, and lying upon the jugular vein, there is a muscle as thin as paper, the platysma myoides, the fibres of which run in an oblique direction from the collar bone to the border of the lower jaw, which is the direction of the vein itself; the incision is made at a right angle with respect to the direction of these fibres, that they may contract and form no obstacle to the issue of the blood. It is also made rather wide, to insure a free issue from the vein. The blood trickles down, and the card is used to direct it into the vessel of reception. To encourage the flow of blood the patient moves the lower jaw, as in mastication, now and then taking a deep breath. When the bleeding is ended, a bit of adhesive plaster is applied over the orifice, and a pledget placed upon it, which is maintained in place by a ligature wound closely, not tightly, round the neck, and fixed with a pin. Bloodletting at the neck is neither difficult nor dangerous, and is performed at times in cases of congestion of blood in the head, as in apoplexy, asphyxia from hanging, etc. - Bloodletting is much less frequently practised now than formerly, and some medical practitioners repudiate the practice altogether; but the most eminent physicians, who combine a scientific education with many years of practical experience in the best hospitals of Europe and America, still recognize the necessity of blood-lotting in some cases, as a means of producing immediate results of a salutary nature, where the life of the patient would be endangered by delay.
Physiology forbids the loss of blood on all occasions of trilling indisposition, especially in feeble constitutions and in city populations, as was formerly of frequent occurrence in medical practice. Both leeching and general bleeding are practised now more cautiously than formerly; and cupping, as a substitute for leeching, is practised with the same discretion by well educated physicians.