1 64 SURGICAL APPLIED ANATOMY, rchap. ix 



Great vessels. The course, relations, and ab- 

 normalities of the great cervical vessels, together with 

 the operations whereby they may be ligatured, and 

 the details pertaining to those procedures, are so fully 

 given, not only in works on operative surgery, but 

 also in the chief anatomical text-books, that nothing 

 need be said upon the matter in this place. The 

 bifurcation of the common carotid is a favourite 

 locality for aneurism, being a point where some re- 

 sistance is offered to the blood current. These tumours, 

 also, are common at the root of the neck, where they 

 are often due to extension of aneurismal disease from 

 the aorta, although in many cases they have an in- 

 dependent origin. It is in the neck that the treat- 

 ment of aneurism by the distal ligature is most often 

 carried out. There is no place in the body where 

 Brasdor's operation can be carried out with the 

 completeness with which it can be adopted in the 

 neck. In this procedure a main trunk is ligatured 

 on the distal side of an aneurism, no branches inter- 

 vening between the sac and the ligature. The cure 

 by this measure depends upon the fact that blood 

 does not continue to go to parts when once the 

 need for blood in them is diminished. Thus, after 

 amputation at the hip joint, the femoral artery, having 

 no need to carry to the stump the amount of blood it 

 brought to the limb, often shrinks to a vessel no larger 

 than the radial. When an aneurism low down 

 in the carotid artery is treated by ligature of the 

 vessel near its bifurcation by Brasdor's method, the 

 blood, having now, as it were, no object in entering 

 the carotid trunk, soon ceases to fill the vessel entirely, 

 and the artery (and in successful cases the aneurism) 

 shrinks in consequence. Wardrop's operation, or the 

 distal ligature of large brandies for the relief of 

 aneurism of a main trunk, is now, perhaps, quite 

 limited as to its performance to the ligature of the 



