The Axilla. 45 



hence a large trunk might be opened with serious results. 

 In the removal of adipose tissue or of lymphatic glands 

 from the axilla it is best first to identify the axillary vein 

 and work from it inwards, rather than in the reverse di- 

 rection, since in the latter case the vein might be inad- 

 vertently wounded. 



Operations on Axillary Artery. Compression. 

 The line of the axillary artery has already been referred 

 to, and to compress it in the case of a wound of the vessel 

 or of its larger branches the best situation is the third 

 part, since the first part lies too deeply placed and has the 

 pectoralis major as well as the dense costo-coracoid mem- 

 brane in front of it, while in the second part the pectoralis 

 major and minor prevent the employment of sufficient 

 force to compress it, and besides, there is nothing suf- 

 ficiently prominent behind the artery in this second part 

 to compress it against, whereas in the third part the 

 artery lying to the inner side of the humerus may be 

 compressed by means of the fingers or a pad pressing out- 

 wards against the bone, and the guide to this part of the 

 vessel is the inner side of the humerus just behind the 

 coraco-brachialis at the upper part of the arm. When 

 pain or numbness down the arm results from this com- 

 pression of the artery it is due to the pad or fingers press- 

 ing on the nerves in the vicinity of the vessel, viz., the 

 trunk of the median which lies on the outer side above 

 or the inner head of this nerve crossing and therefore 

 lying in front of the artery. On the inner side of the 

 vessel the pain might be due to pressure on the ulnar, 

 the internal cutaneous or the musculo spiral nerves. 

 Ligationvi the artery is never performed on the second 

 part of the vessel, as it lies too deeply situated beneath 

 the pectoralis major and minor, nor is it advisable to at- 

 tempt ligating it in the first part of its course for reasons 



