Part 22

C. Sternal end of the right clavicle.

D. Trachea.

E. Right sterno-thyroid muscle, cut.

F. Right sterno-hyoid muscle, cut.

G. Right sterno-mastoid muscle, cut.

a. Right vagus nerve, crossing the subclavian artery.

b. Anterior jugular vein, piercing the cervical fascia to join the subclavian vein.

PLATE 10.

A. Common carotid artery of left side.

B. Left subclavian artery, having b, the vagus nerve, between it and A.

C. Lower end of left internal jugular vein, joining--

D. Left subclavian vein, which lies anterior to d, the scalenus anticus muscle.

E. Anterior jugular vein, coursing beneath sterno-mastoid muscle and over the fascia.

F. Deep cervical fascia, enclosing in its layers f f f, the several muscles.

G. Left sterno-mastoid muscle, cut across, and separated from g g, its sternal and clavicular attachments.

H. Left sterno-hyoid muscle, cut.

I. Left sterno-thyroid muscle, cut.

K. Right sterno-hyoid muscle.

L. Right sterno-mastoid muscle.

M. Trachea.

N. Projection of the thyroid cartilage.

O. Place of division of common carotid.

P. Place where the subclavian artery passes beneath the clavicle.

Q. Sternal end of the left clavicle.

COMMENTARY ON PLATES 11 & 12.

THE SURGICAL DISSECTION OF THE AXILLARY AND BRACHIAL REGIONS, DISPLAYING THE RELATIVE ORDER OF THEIR CONTAINED PARTS.

All surgical regions have only artificial boundaries; and these, as might be expected, do not express the same meaning while viewed from more points than one. These very boundaries themselves, being moveable parts, must accordingly influence the relative position of the structures which they bound, and thus either include within or exclude from the particular region those structures wholly or in part which are said to be proper to it. Of this kind of conventional surgical boundary the moveable clavicle is an example; and the bloodvessels which it overarches manifest consequently neither termination nor origin except artificially from the fixed position which the bone, R, assumes, as in Plate 11, or c*, Plate 12. In this position of the arm in relation to the trunk, the subclavian artery, B, terminates at the point where, properly speaking, it first takes its name; and from this point to the posterior fold of the axilla formed by the latissimus dorsi muscle, O, Plate 11, N, Plate 12, and the anterior fold formed by the great pectoral muscle, K, Plate 11, I, Plate 12, the continuation of the subclavian artery is named axillary. From the posterior fold of the axilla, O P, Plate 11, to the bend of the elbow, the same main vessels take the name of brachial.

When the axillary space is cut into from the forepart through the great pectoral muscle, H K, Plate 11, and beneath this through the lesser pectoral muscle, L I, together with the fascial processes which invest these muscles anteriorly and posteriorly, the main bloodvessels and nerves which traverse this space are displayed, holding in general that relative position which they exhibit in Plate 11. These vessels, with their accompanying nerves, will be seen continued from those of the neck; and thus may be attained in one view a comparative estimate of the cervical and axillary regions, together with their line of union beneath the clavicle, c*, Plate 12, R, Plate 11, which serves to divide them surgically.