The elbow-joint being extended, the hand supinated, an incision may be made, commencing at the internal margin of the median basilic vein, about an inch above the internal condyle, and carried downwards and a little outwards for above two inches and a half, along the radial margin of the pronator radii teres muscle. The vein and external lip of the wound being drawn outwards, the fascia and semilunar process of the biceps tendon may be successively divided on a director. At the bottom of the wound will be found the biceps tendon externally, the median nerve internally, and the artery between both and a little behind them. The needle may then be passed behind the artery from within outwards. Several small branches of the internal cutaneous nerve are necessarily divided in this operations. The superficial veins should be carefully kept out of the way; if one of them, however, should unavoidably interfere with the operation, Velpeau advises to "cut it between two ligatures, or even without this precaution, if not very large".

If the operations be performed for a wound in the artery accompanied with an extravasation of arterial blood, we should cut through the sac and turn out the coagulated blood: the surgeon will be obliged, generally speaking, to relax the tourniquet in order to ascertain the situation of the orifice in the bleeding vessel, and by the introduction of a probe in the opening he will be able still more clearly to discover its precise situation and extent. Having raised the artery from its bed and separated it from the median nerve, a double ligature should be passed beneath it: this ligature should be afterwards divided into its two separate portions, and the artery secured above and below the wound. This is the treatment which Scarpa recommends for diffuse aneurism following a wound of the brachial artery.

The surgeon would, however, do well to remember that where there has been a considerable extravasation of blood as the result of the wound of the artery, into the areolar tissue of the limb, the relative position of the parts will be greatly altered from that which we have just described. The entire of the bend of the elbow may be found filled with coagulated blood and enormously distended, so that in order to obtain a view of the tendon or of the nerve or artery, it will be essen-tially necessary to turn out completely the coagula, and then only can he expect to discover the bleeding vessel.

The branches of the brachial artery as it passes along the arm are the following:

Superior Profunda. Inferior Profunda.

Arteria Nutritia. Anastomotic.