466 



THE BRACHIAL OR HUMERAL ARTERY. 



rior profunda passes backwards between the os 

 humeri and the long head of the triceps, and in 

 company with the musculo-spiral nerve enters 

 the spiral groove on the posterior surface of 

 the bone, passing between the second and third 

 heads of the triceps. About the middle of the 

 arm it divides into two branches, the internal or 

 ulnar, and the external or radial. The ulnar 

 branch descends in the substance of the triceps 

 to the olecranon process, around which it anas- 

 tomoses with the posterior ulnar and inter- 

 osseous recurrent arteries, having in its course 

 supplied the triceps with several branches. The 

 radial branch comes forward with the musculo- 

 spiral nerve as far as the external intermuscular 

 ligament, where it separates from the nerve 

 and taking a more superficial course, descends 

 along the outer margin of the humerus over the 

 supinator radii longus and the triceps, to which 

 and the integuments it gives several branches. 

 On arriving at the external condyle it gives 

 branches to the elbow-joint, and anastomoses 

 with the radial recurrent in front, and the recur- 

 rent of the interosseous artery posteriorly. 



Below the origin of the superior profunda a 

 small artery, called nutritia humeri, frequently 

 arises either from the superior profunda or the 

 brachial trunk : it enters the nutritious foramen 

 of the humerus, and is distributed to the can- 

 cellated structure of that bone. 



2. The inferior profunda (ramus alius pos- 

 terior humeri, Haller) arises from the internal 

 side of the brachial artery, generally about the 

 lower part of the insertion of the coraco-brachialis 

 into the os humeri ; passing backwards, it per- 

 forates the internal intermuscular ligament, be- 

 hind which it descends, having the ulnar nerve 

 internal to it until it arrives at the posterior side 

 of the internal condyle, in the grooved depres- 

 sion between which and the olecranon it lies 

 close on the periosteum, and is covered by 

 the ulnar nerve : here it divides into several 

 branches, some of which are distributed to the 

 elbow joint and the muscles attached to the 

 internal condyle and olecranon, and it anasto- 

 moses freely with the posterior ulnar recurrent 

 artery. Sometimes the inferior profunda is a 

 branch of the superior artery of that name ; it 

 varies very much as to its size in different 

 subjects, being sometimes a very insignificant 

 twig, while in other instances it is so large 

 that it is liable to be mistaken by an ope- 

 rator for the brachial trunk. In reference to 

 this latter circumstance Professor Harrison ob- 

 serves,* " In the dissected arm, the inferior 

 profunda artery appears at some distance from 

 the brachial, but if the triceps be pressed for- 

 ward towards the biceps, so as to place these 

 muscles as nearly as possible in their natural 

 relations, those vessels will be found very close 

 to each other ; so that, in cutting down upon 

 the brachial artery in the middle of the arm, in 

 the living subject, the inferior profunda, from 

 its situation, and from its being accompanied 

 by the ulnar nerve, may be mistaken for the 

 brachial. This error, however, may be avoided 

 by recollecting that the brachial artery is the 



t Surgical Anat. of the Arteries, vol. i. p. 176. 



nearest to the triceps, and is a little covered by 

 that muscle : in general, also, there is a material 

 difference in size between the two vessels." 



The remarks contained in the foregoing quo- 

 tation do not apply to a merely hypothetical 

 case, but to one which has actually occurred in 

 practice, the following instance of which I once 

 had an opportunity of witnessing. A late emi- 

 nent surgeon undertook to tie the brachial artery 

 for the cure of an aneurism at the bend of the 

 elbow: the inferior profunda, which was un- 

 usually large, was exposed and tied on the 

 supposition of its being the brachial artery, 

 the pulsation in the tumour continuing un- 

 diminished pointed out the nature of the mis- 

 take which had been committed, and the patient 

 had to submit to a second operation at a sub- 

 sequent period, in which the brachial artery was 

 tied with a successful result as to the cure of the 

 aneurism.* 



3. The anastomotica magna, (ramus anasto- 

 moticus, Haller, collaterale du coude, Ch.) arises 

 generally at nearly a right angle from the inner 

 side of the brachial, at a little distance above 

 the elbow-joint. Several similar vessels, but of 

 much smaller size, arise from the same source in 

 its vicinity : at first it passes inwards across the 

 brachiaeus anticus, and perforates the internal 

 intermuscular ligament, giving branches to the 

 brachiaeus anticus, the triceps, the cellular tissue 

 and lymphatics above the internal condyle: 

 having got upon the triceps, it descends to the 

 back part of the internal condyle, where it 

 anastomoses with the inferior profunda and 

 posterior ulnar recurrent arteries. When the 

 inferior profunda happens to be very small, or 

 is absent, this vessel supplies its place by giving 

 branches to the articulation, to the muscles at- 

 tached to the internal condyle, and for anasto- 

 mosis with the posterior ulnar recurrent. Where 

 the anastomotica magna is absent, small branches 

 from the brachial, inferior profunda, and ulnar 

 recurrent arteries, supply its place. When a 

 high division of the brachial artery occurs, the 

 branch which is to become the ulnar usually 

 gives off the two profundae, and the anasto- 

 motica magna: this last, however, sometimes 

 comes from the radial in such cases.f 



* [Such a mistake as that alluded to in the text 

 may likewise occur where there has been a high 

 bifurcation of the brachial artery. ED.] 



t [The frequent occurrence of irregularity as to the 

 position at which the brachial trunk divides into its 

 terminal branches, the radial and ulnar, constitutes 

 a point of great interest in the anatomical history 

 of this artery. I believe it may be said that it never 

 happens that the bifurcation takes place below the 

 coronoid process of the ulna ; on the contrary, the 

 division above that point is by no means uncommon, 

 occurring, according to the calculation of Professor 

 Harrison, once in every four subjects. This bifur- 

 cation occurs at all points in the arm, and in some 

 cases the radial and ulnar arteries proceed at once 

 from the axillary. In general the anomalous artery 

 is the radial, and is subcutaneous in its course, 

 while the ulnar follows the normal course of the 

 brachial trunk. Sometimes the reverse is the case : 

 sometimes both radial and ulnar are subcutaneous, 

 and sometimes the radial is at its origin ulnad, 

 but afterwards crosses the ulnar artery at a very 

 acute angle, to get to the radial side. In some rare 

 cases the brachial artery is regular in its course, 



