ANATOMICAL AND PHYSIOLOGICAL FACTORS /O 



or be forced through the Eustachian tube (auditory canal) to the 

 middle ear or to any of the adjacent stiuctures covered by exten- 

 sion of the mucous membrane of the nose and throat. 



Lymphogenous Extension. — All of the structures just men- 

 tioned, as well as all of the tissues of the body, are extensively 

 supplied with lymphatics which drain into regional lymph glands 

 (see Figs. 2, 3, and 4). The spread of vaccine virus by the lym- 

 phatics described by Yoffey and Sullivan (1939) has been men- 



Fig. '2. — I'ortals of infection and the most frequent nodes involved in tubei"- 

 tiilo.sis of the cervical lymph nodes. (After Ki.sendrath, Surgical Diagnosis, 

 V>. 171, by permission of Sv. B. Saunders Company.) 



M, Uppermost node along internal jugular vein. T, Tonsillar gland. S, Sub- 

 maxillary nodes. V, Internal jugular vein. C-P-J, and other lymph nodes in 

 cei'vical region. 



tioned earlier in this chapter. Infections of the tonsil drain into 

 the tonsillar gland ; infections of the floor of tlie mouth drain into 

 the submental glands; from the adenoids into both the tonsillar 

 gland and the internal jugular group, the latter also receiving 

 lymphatic drainage from the ear. These various lymph glands 

 communicate with others in the cervical region and in some cases 



