248 The Axilla 



thoracic as an additional external mammary for the supply of the 

 gland. 



The artery may be accompanied by two venae comites instead of by 

 the single venous trunk. 



The axillary artery can be compressed in the lowest part, where 

 it is comparatively superficial, by thrusting the fingers under the pecto- 

 ralis major and gently driving the vessel outwards against the humerus, 

 under the coraco-brachialis and biceps. 



It is not practicable to compress the beginning of the artery ; cir- 

 culation is easily arrested, however, in the subclavian instead. 



Xiigation of the axillary artery may be performed in the first 

 part of its course (but, as the vessel can be here reached only with 

 danger and difficulty, the surgeon prefers to tie the subclavian, p. 229). 

 The arm having been drawn from the side, so as to raise the clavicle 

 and its muscle from the vessel, a slightly curved incision is made 

 below the inner three-fourths of the clavicle, through the skin, super- 

 ficial fascia and platysma, and the deep fascia, dividing a small super- 

 ficial vein, perhaps, which links the cephalic and the external jugular. 

 The cephalic vein is turned outwards from the pectoral muscle, which 

 is to be divided at its clavicular origin, and the finger then feels for 

 the pectoralis minor. The costo-coracoid membrane is torn through 

 with the dissecting-forceps and director, care being taken not to 

 wound the cephalic vein or the acromial thoracic artery as they 

 traverse the membrane. 



Then a loose sheath surrounding the vessels is torn through, and 

 the artery is separated from the vein on its inner side and the brachial 

 plexus on the outer. The needle is passed from the vein-side. The 

 ligature is probably applied below the level at which the cephalic vein 

 crosses the artery. 



Of the axillary lymphatic glands, some are placed along the 

 axillary vessels, and receive the lymph from the arm, whilst the 

 thoracic set, which lie along the lower border of the pectoralis 

 minor, receive their lymph from the mamma and the front of the chest. 

 Other glands, which are deep in the arm-pit, are associated with 

 the lymphatics of the back. A gland or two in the infra-clavi- 

 cular fossa (p. 241) receive lymphatics passing up with the cephalic 

 vein. 



The superficial and deep lymphatic vessels for the most part follow 

 the veins ; those running up the fore-arm join a small group of lym- 

 phatic glands which are situated near the brachial artery, above the 

 inner condyle of the humerus. 



In examining for enlarged lymphatic glands, as in suspected 

 scirrhus of the breast, the front of the fingers should be laid flat upon 

 the ribs, and the arm should be brought to the side so that the axillary 

 floor may be rendered slack. I have known the inner border of the 

 head of the humerus taken for an enlarged gland when the arm was 



