The Axilla. 47 



process and therefore away from the vessel, although in 

 this situation there would be a possibility of mistaking 

 one of the large trunks of the brachial plexus for the 

 artery. With the above dangers in view one can readily 

 understand that ligation of the first part of the axillary 

 artery is rarely attempted, besides, when the wound of the 

 vessel or of its branches is in such a position as to neces- 

 sitate the application of a ligature to the artery high up, 

 it is much safer and easier to ligate the third part of the 

 subclavian artery than it is the first part of the axillary. 

 Ligation of the third part of the axillary is done 

 through an incision two inches in length made in the 

 course of the vessel, and about the junction of the anter- 

 ior and middle thirds of the antero-posterior fold of the 

 axilla. The 'skin and superficial fascia having been 

 incised, the deep fascia is exposed and carefully divided 

 and the deep landmarks sought for. These are the 

 relations to the vessel of the coraco-brachialis muscle and 

 the median nerve which lie to its outer side, and of the 

 axillary vein and ulnar nerve that lie to the inner side of 

 the artery. Should a nerve present itself in the incision it 

 may be the median or the ulnar and gentle traction will 

 tell which it be, for, it the median, it will be felt by the 

 finger placed on the inner side of the biceps tendon at the 

 bend of the elbow ; if the ulnar, by the finger behind the 

 internal condyle. Should it be the median nerve then the 

 vessel must be sought for on the inner side of the nerve ; 

 if the ulnar, the artery will be found external to it, while 

 if the vein present itself, the artery will be found on the 

 outerside of it also. It must not be forgotten that the 

 median nerve occasionally lies over the vessel in this 

 situation, and the pulsations of the artery being conveyed 

 to the nerve may cause it to simulate the vessel. When 

 the identity of the artery has been established it should be 



