A treatise on operative surgery : comprising a description of the various processes of the art, including all the new operations : exhibiting the state of surgical science in its present advanced condition / by Joseph Pancoast.

  • Pancoast, Joseph, 1805-1882.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on operative surgery : comprising a description of the various processes of the art, including all the new operations : exhibiting the state of surgical science in its present advanced condition / by Joseph Pancoast. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

    32/562
    parts, [n children and females and obese individuals of the male «hc accumulation of adipose matter is, mainly, in front of the veins, so as to render in many cases their location obscure, and only indicated to the presence of the finger, as soft elastic rolling cords. But in a majority of subjects they are obvious to the eye, and stand out in relief on the arm. There is such great varia- tion also in regard to the size, number, and course of the super- ficial veins of this region, that we scarcely find two individuals m which they are exactly the same. Even in the arms of the same person they are very commonly found to vary. The veins as they come up from the forearm may, however, be arranged into three classes. 1. Those from the outer side of the forearm and hand, which usually form a trunk, passing over the outer side of the elbow joint, called the superficial radial. 2. Those from the inner and back part of the forearm and hand, forming on the same side of the elbow the superficial ulnar vein. 3. Those which come up on the middle and front part of the forearm, and form, by their union near the middle of the bend of the arm, the superficial median, which shortly after its formation divides into two branches like the letter Y.* One of these branches, called the median cephalic, runs obliquely outward across the bend of the arm, to join the superficial radial, and forms with it the com- mon trunk called the cephalic vein, which runs up along the outer side of the arm, and passing between the deltoid and great pectoral muscle, opens into the axillary vein, just below the cla- vicle. The other branch, called median basilic, crosses to the inner side of the arm and joins with the superficial ulnar, to form the proper basilic vein, which empties into the brachial • Very frequently this median vein does not branch but runs inwards as a single trunk to join the ulnar. Occasionally it will be observed running out- wards, in the same manner to join with the radial. at a variable distance above the elbow. From the deep-seated radial vein which accompanies the artery of that name, there is an anastomosing branch (vena communicans) which pierces an opening in the deep fascia at the outer side of the tendon of the biceps muscle, and discharges into the median vein just before its bifurcation, thus increasing the amount of blood that flows through this vein. Occasionally it opens into the median basilic. There are, therefore, five superficial veins at the bend of the arm, either of which may be opened in venesection; the radial, the ulnar, the median and the two branches of the latter—the median cephalic, and median basilic. The superficial radial and ulnar, are usually the smallest of the whole, and are so surrounded with branches of the cutaneous nerves, especially the ulnar, (see Plate 3,) that they should not be selected for the operation, except in cases where the other veins are either wanting, or imperceptible. The radial under equal circum- stances, though it does not bleed so freely, is to be preferred to the ulnar, as the latter cannot be opened without risk of injury to the nervous filaments that cover it in front, which though not so serious an accident as formerly supposed, it is desirable to avoid. As the nerves run nearly parallel with these veins, the risk of injuring the former will be diminished by making the opening with the lancet, parallel with the course of the vessel. A slightly oblique cut is, however, usually preferred even here, as it is found to give blood in a larger stream than one exactly parallel. The median vein, before its division, is occasionally opened: while yet deeply situated in the interstice between the mass of muscles of the two sides of the forearm, it is surrounded with nervous filaments, and has the brachial artery placed below it, and so near, especially in thin subjects, that there is some risk of wounding that vessel. But when it lies on either side of this interstice or PLATE III.-PHLEBOTOMY-BLEEDING FROM THE ARM AND FOOT, Fi l.-rhe right arm ,s here represented, prepared for the operation at the bend of the elbow. The circular liga- hleifl)' hT T {hu anteri°r ^ °Uter ^ °f the Hmb' haS CaUSed a dlstesi0» of <he s»Perfi^ veins h, ill' 7,whare , ur aS U,eyare f°Und eXiStlng iD ,he greater mmiber of cases: 0)> the median Ftg. 2and 3, exhibit the surgical anatomy of the elbow, in reference to the operation In fi. 2 the veins absorb mg, tL Cfefer eaPt ^f 7 ^T* JlTl ^ ^ * *%T ** P0JtS *» ^ the arm; (7), fig 2 and 3 the branrhP, nf th * ' ? PnnCipal gr°UP °f the absorb™t vessels of rtit»nM1ifii 1 r u branches of the external cutaneous nerve; (8) the internal cutaneous nerve- (Q) a cutaneous filament of the ulnar nerve; (10), the brachial artery; (n), thesitellite veins; (l2), tClTZ^e. BLEEDING FROM TBE INTERNAL SAPHENA. Pig. 4, shows the manner of bleeding in the internal saphena vein. (1), A prominence formed bv th'P i , , aphena, which is a continuation of the external vein of the foot. (2), The left thumb of thTonefa Z7 the vemon the malleolus to prevent its rolling, while with the right, hand the surgeon ope, the ^ ( T figure (d) below, the lancet is held in the proper position for making the puncture for blood 1 ttmg ' ^