He makes an incision two and a half inches long, which passes from the internal end of the clavicle obliquely upwards and outwards in the direction of the interval between the two origins of the sterno-cleido-mastoid muscle. The skin, platysma, and deep fascia are successively divided, the two portions of the muscle drawn apart with the edges of the wound, and the internal jugular vein is reached inside the anterior scalenus and phrenic nerve. The sheath of the vessel is opened, the vein drawn to the outside, and the artery sought at its internal side. The decided objection to this operations is that there is the greatest possible danger of wounding the internal jugular vein, which lies at the bottom of this incision, and which, if distended, as it is most likely to be during the operation, from the struggles of the patient or from other causes, will present itself in such a manner as to obscure the artery from the view of the surgeon. In a word, the operator, instead of getting into that compartment of the sheath which contains the artery, gets into that which contains the vein.

* Operative Surgery, p. 68.