THE SUPERFICIAL VEINS OF THE UPPER EXTREMITY 733 



it is formed by the junction of the two preceding veins, and, passing upward 

 and outward, joins the median basilic to form the basilic vein. When it does 

 not exist the anterior and posterior ulnar veins open separately into the median 

 basilic vein. 



The radial vein (v. radialis) (Figs. 510 and 511) commences upon the dorsal 

 surface of the wrist, and communicates with the deep veins of the palm by a branch 

 which passes through the first interosseous space. The radial vein soon forms a 

 large vessel, which ascends along the radial side of the forearm and receives 

 numerous veins from both its surfaces. At the bend of the elbow it unites with 

 the median cephalic to form the cephalic vein. 



The median vein (v. mediana cubiti) (Fig. 510) ascends on the front of the 

 forearm, and communicates with the anterior ulnar and radial veins. At the bend 

 of the elbow it receives a branch of communication from the deep veins, the deep 

 median vein, and divides into two trunks, the median cephalic and median basilic, 

 which diverge from each other as they ascend. 



The median cephalic (v. mediana cephalica) (Fig. 510), usually the smaller of 

 the two, passes outward in the groove between the Brachioradialis and Biceps 

 muscles, and joins with the radial to form the cephalic vein. The branches 

 of the external cutaneous nerve pass beneath this vessel. 



The median basilic vein (v. mediana basilica) (Fig. 510) passes obliquely in- 

 ward, in the groove between the Biceps and Pronator teres muscles, and joins the 

 common ulnar to form the basilic. This vein passes in front of the brachial 

 artery, from which it is separated by a fibrous expansion, the bicipital fascia, 

 which is given off from the tendon of the Biceps to the fascia covering the Flexor 

 muscles of the forearm. Filaments of the internal cutaneous nerve pass in front 

 as well as behind this vessel. 



Venesection is usually performed at the bend of the elbow, and as a matter of practice the 

 largest vein in this situation is commonly selected. This is usually the median basilic, and 

 there are anatomical advantages and disadvantages in selecting this vein. The advantages are, 

 that, in addition to its being the largest, and therefore yielding a greater supply of blood, it is 

 the least movable and can be easily steadied on the bicipital fascia on which it rests. The dis- 

 advantages are, that it is in close relationship with the brachial artery, separated only by the 

 bicipital fascia; and formerly, when venesection was frequently practised, arteriovenous aneu- 

 rism was no uncommon result of this practice. Another disadvantage is, that the median basilic 

 is crossed by some of the branches of the internal cutaneous nerve, and these may be divided in 

 the operation, giving rise to "traumatic neuralgia of extreme intensity" (Tillaux). 



Intravenous infusion of normal saline solution is very frequently required in modern surgery 

 for all conditions of severe shock and after profuse hemorrhages, the older method of trans- 

 fusion of blood having sunk into oblivion. The patient's arm is surrounded by a tight bandage 

 so as to impede the venous return, and a small incision is made over the largest vein visible in 

 front of the elbow; a double ligature is now passed around the vein, and the lower one is tied; the 

 vein is then opened and a cannula connected with a funnel by tubing and filled with hot saline 

 solution is inserted. The bandage is next removed from the arm, and two, three, or more pints 

 of fluid are allowed to flow into the vein; when a sufficient quantity has gone in, the upper liga- 

 ture around the vein is tied and a stitch put in the skin wound. 



The basilic vein (v. basilica} (Figs. 511 and 513) is of considerable size and 

 is formed by the coalescence of the common ulnar vein with the median basilic. 

 It passes upward along the inner side of the Biceps muscle and pierces the deep 

 fascia a little below the middle of the arm. The opening in the fascia is known 

 as the semilunar hiatus (hiatus semilunaris}. The vein ascends in the course of 

 the brachial artery to the lower border of the tendons of the Latissimus dorsi and 

 Teres major muscles, and is continued onward as the axillary vein. 



The cephalic vein (v. cephalica) (Figs. 510) is formed by the union of the median 

 cephalic and the radial veins. It courses along the outer border of the Biceps 

 muscle, lying in the same groove with the upper external cutaneous branch of 

 the musculospiral nerve, to the upper third of the arm; it then passes in the interval 



