Jugular vein

“ Larger veins can be used, which will always insure greater success.
The Removal of Blood from the Internal Jugular Vein.
—The internal jugular vein is the largest tributary vein in the body, and accompanies the carotid artery. The operator will cut through the skin at a point from one half inch above the clavicle or collar bone and in the valley formed by the sterno-mastoid muscle to the outside and the muscles of the wind pipe to the inside, cut upward making the perpendicular incision. Raise both the artery and the vein according to the usual method. ”

“ The arterial system is to be injected, and next requires attention. Before commencing to inject the [Pg 54] arteries, the jugular vein on the left side of the neck must be punctured so as to allow the blood to escape. In some subjects, the flow of blood will be very copious, in which instance the jugular veins must be opened on both sides of the neck; at other times the flow of blood will be very limited, and even the opening of the veins has sometimes been found quite unnecessary. ”

“ For thorough bleeding, the jugular vein is generally to be preferred. The sheep should be firmly held by the head by an assistant, and the body confined between his knees, with its rump against a wall. Some of the wool is then cut away from the middle of the neck over the jugular vein, and a ligature, brought in contact with the neck by opening the wool, is tied around it below the shorn spot near the shoulder. The vein will soon rise. The orifice may be secured, after bleeding, as before described. ”

“ The commencements of these veins, when they are first of all divided, are called jugular veins; and having branched off in the neck from the great vein, they are continued to the trachea of the lungs. And if these veins are held on the outside, men fall down dead with insensibility, with closed eyes, but without choking. ”

“ Fig. 65, 5, page 109) .—The external jugular [320] vein comes from the head and face. It is formed by the junction of the anterior (Fig. 131, c) and posterior (b) facial veins near the ventral border of the sternomastoid muscle. It passes thence obliquely across the sternomastoid to the triangular interval between it and the clavotrapezius. ”

“ Many patients have died of this disease, induced by the application of a ligature to the vena saphena major, for the cure of varix. Wounding of large veins ought to be studiously avoided; and if wounded, the bleeding from them should, if possible, be arrested by pressure. When from any cause the extremity of a large vein in a wound is not closed, when it is not plugged up by plastic matter, pus seems to enter it readily, and by mixing with the circulating fluid causes dreadful mischief ”

“ The circulation will then be obstructed in all the distant branches, and the blood, if long retained, will coagulate in them also. It will then part with its serum, and give rise to all the symptoms of inflammation in the distant vessels; a pulpy elastic swelling, accompanied with great pain, will then be the principal symptom, while the turgescence on the surface will be less than where the superficial veins have been mechanically compressed. It will, however, very frequently happen, that a vein in a part may be felt distended without any symptom of inflammation being present ”

“ In operations involving large vessels, the local conditions which may influence the actions in the veins, appear not to have been fully determined; for while some surgeons regard the tying or cutting of a vein as a serious operation, others are in the habit of doing it without any unusual precaution. In operations upon hæmorrhoidal tumours, the veins involved are of some size, and in two of the instances recorded in the Appendix, a ligature applied to them was followed by purulent deposits. ”

“ The symptoms and consequences of inflammation of the vein have been already detailed. The affection is attended with great pain, and with swelling from effusion into the cellular tissue around the course of the vessel; the integuments are inflamed and tense; sero-purulent secretion soon takes place in the infiltrated cellular tissue, both deep and subcutaneous, followed by sloughing, and separation of the skin from its subjacent connexions; even death of the muscular structure sometimes ensues—the pectoral muscles have been found black and soft. The local treatment must be active. ”

“ The examination of the blood, or of the vessels, in such cases, will by no means invariably indicate the presence of foreign matter after it has once become thoroughly mixed with the blood, nor will inflammation of the vein through which the fluid passes, be by any means invariably produced.
When a foreign substance is introduced into an artery, any immediate effects upon the blood may naturally be looked for in the system of capillaries which it supplies. If the blood then coagulates, local symptoms alone, will, in the first instance, be produced, and the constitution will remain unaffected. ”

“ The usual economy of nature, however, is here exercised, with a precision proportionate to the strength of the patient. A simple wound in a vein, in healing by the first intention, will not obstruct the circulation through the vessel under ordinary circumstances. A coagulum will form, sufficient to unite together the divided edges, and the circulation of blood through the vessel will be uninterrupted; [Pg 7] but if the wound does not readily heal, coagula may form, which encroach more or less upon the cavity of the vein. ”

“ Blood then ceases to flow along the allantoic vessels; they become obliterated. The vitelline vein, which as the yolk becomes gradually absorbed proportionately diminishes in size and importance, comes to appear as a mere branch of the portal vein. The ductus venosus becomes obliterated; and hence the whole of the blood coming through the portal vein flows into the substance of the liver, and so by the hepatic veins into the vena cava. ”

“ Venesection, however, does not alleviate the pain unless when it extends to the clavicle. But if the pain be not dissolved by the fomentations, one ought not to foment for a length of time, for this dries the lungs and promotes suppuration; but if the pain point to the clavicle, or if there be a heaviness in the arm, or about the breast, or above the diaphragm, one should open the inner vein at the elbow, and not hesitate to abstract a large quantity, until it become much redder, or instead of being pure red, it turns livid, for both these states occur. ”

“ This remark I have had opportunities of verifying in cases, where needles have been introduced under varicose veins in the lower extremities, and allowed to remain, with a ligature around them, for ten days or a fortnight. The circulation through the vein will in such cases be obstructed; but, in a year or two, will be found to have become completely re-established. ”

“ The process of repair goes on frequently during a continued flow of blood over the part, and sometimes during the constant action of the muscles in the neighbourhood: at other times, an injured vein will be situated immediately in the bend of a joint, and will be subject to be continually bent and extended with the motions of the limb. In the structure of the bones, the veins lie in unyielding channels, and are consequently deprived of the assistance derived from the approximation of their sides, as in soft parts, during the process of reparation. ”

“ If the coagulum be allowed to remain, the vein in which it is formed soon becomes thickened; but, as the experiments cited [Pg 4] prove, this thickening is the effect and not the cause of the stagnation of the vitiated blood in the vessel.
II. When blood coagulates in a serous cavity, a thin pellicle forms upon its surface, and, becoming thickened by deposition from the fibrin of the blood, forms a cyst, which completely circumscribes the effusion. ”

“ He states that persons in extreme heat or cold do not bear bleeding. He mentions that in bleeding from the basilic vein there is danger of wounding the artery, that a nerve lies under the median; but that the cephalic may be opened without danger.
Oribasius gives an interesting dissertation on venesection, principally condensed from the works of Herodotus, Antyllus, and Galen. (Med. Collect. vii.) Antyllus directs us when going to bleed at the elbow to apply a ligature two fingers broad round the arm, so as to produce a swelling of the veins ”

“ Entrance of Air into Veins--Air Embolism.#--This serious, though fortunately rare, accident is apt to occur in the course of operations in the region of the thorax, neck, or axilla, if a large vein is opened and fails to collapse on account of the rigidity of its walls, its incorporation in a dense fascia, or from traction being made upon it. If the wound in a vein is thus held open, the negative pressure during inspiration sucks air into the right side of the heart. This is accompanied by a hissing or gurgling sound, and with the next expiration some frothy blood escapes from the wound. ”

“ It has been shown upon very high authority, that the sides of a vein do not unite after venesection (as has sometimes been presumed to be Mr. Hunter's opinion) ; but that the divided edges only of the vessel are agglutinated by the coagulum, which "serves as a bed to the new membrane." But the case is different, should this first attempt at union fail; the sides of the vessel may then become united, and its cavity for a time obstructed (section iv) . ”

“ Under these last circumstances, we may find a vein partially obliterated at different points, leaving intervals where lymph or pus are secreted. If the purulent matter introduced is allowed to remain a short time only in the vein, no inflammation is produced (Experiment vi) . But when any irritating fluid is detained there in consequence of the blood coagulating around it, adhesive, ulcerative, or suppurative inflammation, will be excited (Experiments vii and viii) .
The slowness with which veins inflame when cut, tied, or bruised, has been made a subject of comment by different authors ”

“ All surgeons are familiar with the good results which follow the application of a poultice to an acutely inflamed surface-part. Quite recently a woman has been under my care with inflammation of the tissues about the internal saphenous vein. She has progressed quite well towards convalescence by keeping the limb at rest, and by having the inflamed vein-track covered with a large poultice of linseed meal; no other treatment has been required. ”

“ Cupiss recommends the brachial vein of the fore-leg (commonly called by farriers the plate-vein) as a favorable place for bleeding. This vein runs along the inner side of the fore-leg under the skin, and the best place for puncturing it is about an inch above the knee, and scarcely half an inch backwards from the radius. No danger need be apprehended from cutting two or three times if sufficient blood cannot be obtained at once. The vein will become easily discernible if a ligature is tied firmly round the leg just below the shoulder. ”

“ The animal regained its appetite, eat and drank freely, and went to sleep. The day following, it appeared nearly well. On the third day, three drachms of the same pus were injected into the opposite vein; after the lapse of a certain time, there occurred, as in the first instance, faintness, vomiting, and frequent desire to pass urine; twelve hours after the injection, frequent liquid, white, and very fetid motions were passed, and the animal died at the expiration of twenty-four hours. On opening the body, no alteration was found either in the intestines or other organs. ”

“ If you have a varicose vein, it will almost for certain be in the leg, and if it bursts, you will feel the hot stream of blood and rapidly become faint. When this occurs, lie down on the floor and elevate the leg as high as you{404} can. This alone may stop the bleeding. If it does not, press your finger on the spot, and then send or call out for assistance. The slightest pressure will stop bleeding from a vein.
In these cases of serious bleeding, send for a surgeon as soon as you have applied pressure. In all probability the vessel will have to be tied. ”

“ The vena ischiatica originates by the union of several venous branches which come from the muscles of the pelvis and upper thigh region. The ischiatic vein enters the pelvic cavity along with the ischiatic nerve and artery, and communicates with the vena hypogastrica at about the level of the anterior lobe of the kidney. It is always smaller than the vena cruralis. ”

“ At the left groin, the iliac vein was greatly distended with pus. Sir Henry Halford [17] has also mentioned three cases of what he has termed phlegmasia dolens, occurring in the male, in one of which the iliac vein was found obliterated after death. In this case, the patient had suffered, for several years before his death, from swelling of the left [Pg 12] leg and thigh. In the interior of the obliterated vessel there is a coagulum, which has lost its colour, and become firm and completely adherent to the inner surface of the vein. ”

“ External piles consist, then, of a protrusion of the hœmorrhoidal vein or veins between the cellular union of the sphincter with other muscles, constituting, in fact, a hernia or rupture in the perinœum. Internal piles is that condition of the hœmorrhoidal veins, where, from their dilatation, they become protruded with the fæces, when, from the contraction of the sphincter acting like a ligature, they can not regain their situation until emptied of their contents. Inflammation soon ensues, and the various changes I have and shall hereafter consider take place. ”

“ The shifting of veins on a small scale is much more common than the larger phenomena of this nature, which are nevertheless of frequent occurrence wherever veins exist. These larger dislocations are known to arise either from the lateral motion or subsidence of the containing parts, the sides of the line of fracture sometimes remaining in contact, and being at others separated by a vein of another description, too well known among miners to need any comment here. ”