50 AN ANOMALY OF THE THORACIC DUCT. 



four lumbar vertebrae. 1 The most anterior of these reaches the body of the eleventh 

 thoracic vertebra. The widest of these vessels is but 2 mm. For the most part they are 

 vessels running from the right lumbar nodes across to the left side, to the left lumbar nodes, 

 or to ducts which pass directly to the left iliac nodes. Some ducts from the plexus, opposite 

 the last thoracic and first lumbar vertebrae, however, wind around the left of the aorta and 

 reach the plexus around the celiac axis and superior mesenteric, which drain the intestines, 

 stomach, and in part the liver. It is quite probable, therefore, that some of the lymph from 

 these organs passed through the plexus which lies in the position of the receptaculum chyli. 



The most anterior part of these lymphatic plexuses consists of a loop which passes 

 from the right lumbar chain, anteriorly, as far as the division of the azygos vein. (Figs. 2 

 and 3, a.) Here, ventral to the azygos, it bends sharply to the left, and, running posteriorly, 

 ventral to the aorta, passes to a gland lying to the left of the aorta, opposite the twelfth 

 thoracic vertebra. It is to be noted that this loop reaches nearly to the level at which the 

 rudimentary thoracic duct ends. The two are here separated by the anomalous azygos 

 connecting branch (fig. 3, conn, v.), which is crossing from left to right, ventral to the 

 aorta. No trace of a connection could be found between the two lymphatics by the most 

 careful dissection. 



Ventral to the aorta there are, in addition to the large lymph node over the bifurcation, 

 two long, flattened nodes lying posterior to the place of origin of the renal arteries (fig. 3). 

 These two nodes are connected with the node over the bifurcation by several vessels running 

 along the aorta. They receive, also, vessels which course across the inferior vena cava, a 

 vessel of considerable size which follows the vena cava as far as the diaphragm, vessels 

 from the plexus around the celiac axis and superior mesenteric artery, vessels from the 

 duodenal region and from the right lumbar glands. The two glands are connected with one 

 another by several vessels. From the left of these two preaortic glands there is a glandular 

 projection which passes dorsally to one of the left lumbar glands. From the left gland two 

 vessels of considerable size run posteriorly, to the left lumbar and left iliac glands. 



The vessels connecting the right lumbar chain of nodes with one another are less 

 numerous than the corresponding vessels on the left side. Vessels were traced from the 

 right chain to the tenth and eleventh intercostal spaces. On the left side, small vessels 

 were found from the tenth and eleventh intercostal spaces which led to ducts passing pos- 

 teriorly to the left lumbar nodes. A curious condition was found in the z'egion of the 

 twelfth rib. A lymphatic loop distended with a whitish coagulum lies to the left of the body 

 of the eleventh vertebra and on the neck of the twelfth rib. It is connected with a con- 

 siderable lymphatic plexus lying to the left of the aorta, which, in turn, is connected with 

 the plexus around the superior mesenteric artery and celiac axis. To the left of the aorta 

 there is a group of lymph ducts, in part interrupted by the left lumbar nodes and in part 

 running free of them, which starts anteriorly with the vessels mentioned draining the tenth 

 and eleventh intercostal spaces, and extends to the iliac nodes. This group receives most 

 of the vessels lying on the bodies of the vertebrae, the left renal and left ovarian lymphatics, 

 and most of the vessels hying ventral to the aorta, including connections with the lymphatics 

 from the intestines, liver, and stomach, which follow the celiac axis and superior mesenteric 

 artery. Some of the ducts pass dorsal and some ventral to the renal arteries. In this region 

 they form a plexus which is interwoven with the plexus of sympathetic nerves. Small 

 vessels from this chain were traced to the pillars of the diaphragm, presumably draining 

 some of the diaphragmatic lymphatics. From the inferior end of the left lumbar nodes a 



'Only four lumbar vertebra; are present in this subject. 



