144 SURGICAL APPLIED ANATOMY. [Chap. ix. 



the inspiratory act, just t as ,, air is drawn. into the 

 : 



The vertebral artery has beeji l^gat^rec] y/ith some 

 be'aefii; in cases t>'f 'epilepsy. The artery is reached 

 through a,n incision made along the posterior border 

 of the sterno-mastoid muscle just above the clavicle. 

 The " carotid tubercle" (see page 119) is then sought 

 for, and vertically below it the artery lies in the gap 

 between the scalenus anticus and longus colli muscles. 

 The procedure is surrounded by considerable diffi- 

 culties. 



Dr. Bright and Dr. Eamskill have stated that 

 disease involving the vertebral artery just before it 

 enters the skull may lead to pain at the back of the 

 head. It is well known that the sub-occipital nerve lies 

 in close connection with the artery over the posterior 

 arch of the atlas, and that it gives a branch to the 

 great occipital nerve which is distributed to the back 

 of the head. The close connection of artery and 

 nerve and this communicating branch may serve to 

 explain the symptom noted. In some of Dr. Ram- 

 skill's cases there was difficulty of articulation. This 

 he ascribes to pressure upon the hypoglossal nerve, 

 which is also in close relation with the vertebral 

 artery. 



The lymphatic glands in the neck are 

 very numerous, and are arranged in the following 

 sets: (1) Submaxillary (10 to 15), situate along the 

 base of the jaw beneath the cervical fascia ; (2) supra- 

 hyoid (1 or 2), situate about the middle line of the 

 neck between the chin and the hyoid bone ; (3) super- 

 ficial cervical (4 to 6), situate along the external 

 jugular vein beneath the platysma ; (4) deep cervical, 

 upper set (10 to 20), situate about the bifurcation of 

 common carotid, and along the upper part of the in- 

 ternal jugular vein ; (5) deep cervical, lower set (10 to 

 16), situate about the lower part of the internal 



