LYMPHATIC AND LACTEAL SYSTEM. 



Fig. 58. 



Superficial lymphatics of the upper extremity. 

 (After Mascagni.) 



a, a, Commencing lymphatic vessels which ac- 

 company the branches of the cephalic and basilic 

 veins. 



6, Lymphatic vessels passing from the posterior 

 to the anterior surface ot the forearm over its inner 

 edge, with branches of the basilic vein 



d, Lymphatic vessels passing from the posterior 

 to the anterior surface of the forearm over its outer 

 edge, with branches of the cephalic vein. 



c, Lymphatic vessels passing from the posterior 

 to the anterior surface of the arm over its inner 

 edge. 



The superficial lymphatics of the upper ex- 

 tremity in their passage to the axillary glands 

 follow more or less the course of the subcuta- 

 neous veins. Those which accompany the ce- 

 phalic and basilic veins commence on the 

 dorsal surface of the fingers, where they com- 

 municate with the digital lymphatics ; from 

 thence they proceed over the metacarpvis to the 

 posterior surface of the forearm, tending with their 

 accompanying veins towards its ulnar and ra- 



dial edges, over which, sooner or later, they 

 pass to gain the anterior surface, and at the 

 bend of the elbow they have all collected in 

 the neighbourhood of the internal condyle. 

 The lymphatics accompanying the median 

 vein take origin from the palmar surface of 

 the fingers, where they communicate with the 

 digital lymphatics; they take their course up- 

 wards first on the palm of the hand, then on 

 the anterior surface of the forearm, and at the 

 bend of the elbow join those already traced to 

 the same point. The great majority of these 

 vessels now continue their course upwards 

 over the internal condyle to the inner side of 

 the aim, some of them traversing the little 

 gland or glands situated just above the internal 

 condyle ; from thence they take the nearest 

 route to gain the axillary glands, of which they 

 form the principal vasa inferential. Some three 

 or four of the lymphatics, which in the forearm 

 were associated with the branches of the ce- 

 phalic vein as far as the bend of the elbow, 

 separate themselves from the rest, and ascend 

 with this accompanying vein on the outer side 

 of the biceps, and in the interval between the 

 deltoid and pectoralis major muscles, where 

 they meet with a gland which they traverse and 

 ultimately pass with the vein over the pectoralis 

 minor muscle to gain the deep-seated lympha- 

 tics accompanying the axillary artery. 



The axillary glands collect their vasa infe- 

 rentia also from the upper half of the anterior, 

 posterior, and lateral surfaces of the trunk. 

 From the anterior surface those on the ab- 

 domen above the umbilicus ascend; those on 

 the upper part of the chest, joined by some 

 from the cervical region, descend ; those on a 

 level with the axilla from the pectoral muscles 

 and the glands of the breast take a transverse 

 direction all in short converging towards the 

 axilla, where the glands in which they termi- 

 nate are situated, from the posterior surface 

 of the trunk in a similar way they concentrate 

 from the lumbar, cervical, and dorsal regions 

 to pass over the posterior border of the axilla 

 to reach the same glands. 



The vasa efferentia of the axillary glands, 

 four or five only in number, but of large size, 

 receive the lymph conveyed to these glands 

 from the various sources just described; they 

 pass associated with the axillary vessels under 

 the subclavius muscle, unite into one or two 

 branches, which usually pass over the subcla- 

 vian vein, to terminate either separately in 

 this vein, close to its union with the internal 

 jugular, or else join the lymphatic trunks. 



The lymphatics of the head and face may be 

 divided as in other parts of the body into the 

 superficial and the deep-seated. They all have 

 to pass through the glands situated in the cer- 

 vical region. The superficial accompany prin- 

 cipally the veins of the head and face. Those 

 from the head form two groups : one anterior 

 associated with the temporal veins, descends 

 in front of the ear, joins the small glands 

 situated at the root of the zygoma, and in 

 the substance of the parotid gland ; it passes 

 with the temporal vein through that gland 

 and below the angle of the jaw continues to 



