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LYMPHATIC GLANDS AND VESSELS OF UPPER EXTREMITY. 867 
the subcutaneous tissue, and form two groups, a lower and an upper. The /ower 
or ante-cubital group is frequently absent; when present it includes two or three 
glands which lie in front of the elbow; they receive afferent vessels from the front 
of the forearm and from the median part of the palm, and they give off efferent 
vessels which pass upwards and inwards along the antero- internal aspect of the 
arm. At varying levels these efferents pierce the deep fascia and terminate in the 
external axillary “glands. The upper or supra-trochlear group lies a short distance 
above the internal condyle; as a rule it includes two glands only, but the number 
may be increased to four; they lie close to the commencement of the basilic vein, 
and their afferent vessels are derived from the inner two or three digits, the inner 
side of the forearm, and the inner side of the palm. Their efferents pass upwards 
along the basilic vein, which they accompany through the opening in the deep 
fascia; they then join the deep lymphatics, which are ascending along the brachial 
artery, and accompany them to the external axillary glands. 
(2) The deep glands lie along the vessels in the axilla and, just below the 
clavicle, in the groove between the pectoralis major and the deltoid muscles. They 
are accordingly divisible into (a) the axillary and (0) the infra-clavicular glands. 
One or two small glands are occasionally found with the arteries of the forearm 
and a few with the brachial artery ; they receive deep afferent lymphatics from the 
adjacent muscles, ligaments, and the bones, and they give off efferent vessels which 
terminate in the external axillary elands. 
(a) The axillary glands are arranged in three groups—external, anterior, and 
posterior. 
(i.) The external group (lymphoglandulz axillares) consists of from six or more 
glands which form a chain along the antero-internal aspect of the axillary vessels, 
extending from the lower border of the pectoralis major to the outer border of 
the first rib. They receive afferent vessels, both superficial and deep, from the 
whole of the upper extremity ; many of these pass directly to the glands from the 
tissues, the remainder include the efferents of the superficial and deep glands 
of the forearm and arm, the efferents of the infra-clavicular glands, and some of 
the efferents of the anterior and posterior axillary glands. The efferents of the 
external axillary glands pass along the subclavian vein, occasionally forming a 
common trunk, and terminate on the right side in the right lymphatic duct, and 
on the left side in the thoracic duct. 
(ii.) The anterior axillary or pectoral glands (lymphoglandule pectorales), 
four or five in number, lie at the anterior part of the axilla, in the angle 
between the pectoral muscles and the serratus magnus. They receive afferent 
vessels from the superficial parts of the anterior and lateral walls of the body 
above the umbilicus, and from the outer two-thirds of the mammary gland. Some 
of their efferents pass to the external axillary glands, but the majority accompany 
the efferent vessels of the latter glands to their termination. 
(iii.) The posterior or subscapular set of axillary glands (lymphoglandule 
subscapulares), four or five in number, le along the sides of the subscapular 
artery on the posterior wall of the axilla. Their afferents are the superficial 
lymphatics of the lateral and posterior parts of the body -wall, above the 
umbilicus and the superficial lymphatics of the lower and back part of the neck. 
Their efferents either join the external axillary glands, or they pass to the root 
of the neck, where they anastomose with the lower cervical lymphatics, and end 
either in the right lymphatic or the thoracic duct, according to the side on which 
they are situated. 
(b) The infra-clavicular glands lie deeply in the groove between the 
pectoralis major and the deltoid muscles, directly below the clavicle. They receive 
afferents from the outer side of the arm and the shoulder, which accompany the 
cephalic vein, and their efferents pass to the external axillary glands or to the 
lower deep glands of the neck. 
The lymphatic vessels of the upper extremity are, like the glands, arranged 
in two sets, (1) the superficial and (2) the deep. 
The superficial lymphatic vessels commence in cutaneous plexuses which are 
finest and most dense on the palmar aspects of the fingersand hand. The efferents 
