chap, xiii.] REGION OF ELBOW. 215 



the one the nearest to the surface ; it is also the 

 least movable vein, and the one the least subject 

 to variation. The bicipital fascia forms an excel- 

 lent protection to the brachial artery during 

 phlebotomy. The density of that membrane varies, 

 arid depends mainly upon the degree of muscular 

 development. In thin subjects the median basilic 

 vein may receive pulsations from the subjacent 

 artery. According to one observer, the walls of 

 this vein are often as thick as those of the popliteal 

 vein. The ulnar, radial, and median veins seldom 

 yield enough blood on venesection, since they are 

 below the point of junction of the deep median 

 vein, and thus do not receive blood from the deep 

 veins of the limb. The brachial artery has, as may 

 be supposed, been frequently injured in bleeding ; and 

 at the period when venesection was very commonly 

 practised, arterio-venous aneurisms at the bend of 

 the elbow were not infrequent. Since the principal 

 superficial lymphatic vessels run with these veins, 

 and since some of them can scarcely escape injury in 

 phlebotomy, it follows that an acute lymphangitis 

 is not uncommon after the operation, 'especially when, 

 the point of the lancet being unclean, septic matter is 

 introduced into the wound. 



The internal cutaneous nerve, which usually runs 

 in front of the median basilic vein, may be wounded 

 in bleeding from that vessel. The injury to the 

 nerve, according to Tillaux, may lead to " traumatic 

 neuralgia of extreme intensity, and very chronic." 

 A "bent arm " may follow after venesection, and 

 Mr. Hilton believes this to be often due to injury 

 to the filaments of the musculo-cutaneous nerve, 

 especially to the inclusion of those filaments in a 

 scar left by the operation. These peripheral fibres 

 being irritated, the muscles supplied by the nerve 

 (biceps and brachialis anticus) are caused to contract 



