148 SURGICAL ANATOMY OF 



and radial recurrent vessels ; in the inner, the brachial 

 artery, its venaB comites, and the median nerve. 



The braehial artery at the bend of the elbow lies in the 

 middle of this space, at first superficial, and afterwards, 

 before it divides, deep, and opposite the coronoid process 

 forms the radial and ulnar, and has the following rela- 

 tions : In front, integument and superficial fascia, me- 

 dian basilic vein, bicipital fascia ; externally, tendon of 

 biceps ; internally, median nerve ; posteriorly, the brachi- 

 alis anticus. 



The lymphatics are both superficial and deep, the 

 former lying upon the aponeurosis, and communicating 

 with one or more large ganglia immediately over the 

 anterior aspect of- the inner condyle ; these ganglia be- 

 come enlarged in poisoned wounds of the finger, and in- 

 durated in constitutional syphilis. The deep ones fol- 

 low the course of the arteries. This aspect of the region 

 is of the highest surgical importance, as in the operation 

 of bleeding from the median basilic vein, there is a chance 

 of wounding the brachial artery ; in the event of such 

 an accident occurring, either an aneurismal varix, or 

 varicose aneurism, or a diifuse or circumscribed trau- 

 matic aneurism, might be the result. Arterial hemor- 

 rhage from wounds in this region, can be generally con- 

 trolled by extreme flexion of the arm, aided by a pad of 

 lint or small roller. Owing to the great number of inos- 

 culating vessels lying round the joint, there is considera- 

 ble chance of secondary hemorrhage. 



The posterior aspect of the region of the elbow presents 

 for examination the olecranon process of the ulna, be- 

 tween which and the integument is a bursa ; external to 

 the olecranon can be felt the articulation of the head of 

 the radius with the capitellum ; and internally a deep 



