480 Anatomy Applied to Medicine and Sutgery. 



anticus, since this muscle becomes prominent each time 

 the head is turned in this manner. The vessel is sought 

 for, as it lies -at the angle of junction of the muscle with 

 the rib, and the needle is introduced from above, down- 

 wards, so as to avoid the cord formed by the last cervical 

 and the first dorsal nerves, while the left forefinger, 

 guarding the needle, protects the pleura. Vertebral. 

 An incision three inches long is made from the clavicle, 

 upwards, along the posterior border of the sterno-mastoid 

 muscle, the external jugular vein is avoided, and, with 

 the muscle, is drawn inwards, the transverse process be- 

 longing to the sixth cervical vertebra is sought for, and, 

 below it, the operator will find the artery lying between 

 the scalenus anticus and the longus colli muscles. The 

 vertebral vein and the internal jugular will be found lying 

 in front of the vessel and must be avoided. External 

 carotid. This artery is best ligated below the posterior 

 belly of the digastric rather than above it, and may be 

 secured as follows : An incision, reaching from about the 

 angle of the jaw to the middle of the thyroid cartilage, is 

 made, so that its centre will be opposite the tip of the 

 greater cornu of the hyoid bone. The skin, platysma and 

 superficial fascia are divided, the deep fascia is opened, 

 the anterior border of the sterno-mastoid located, and the 

 muscle drawn outwards. The digastric and the hypo- 

 glossal nerves should be identified at the upper angle of 

 the wound and the artery exposed opposite the cornu of 

 the hyoid, avoiding, in so doing, the facial and superior 

 thyroid veins which cross the vessel. 'The artery is 

 ligated between its lingual and superior thyroid branches, 

 by passing the needle from without inwards, carefully 

 avoiding the superior laryngeal nerve, which passes be- 

 hind the vessel in this situation. Lingual. This artery 

 is best secured at the "Place of Election," i.e., beneath the 



