964 



HUMAN ANATOMY. 



toward the webs of the fingers and pass dorsally to join the stems which pass upward 

 over the intermetacarpal spaces ; the inner portions pass over into a number of small 

 stems which curve around the inner border of the hand to join the stems coming from 

 the little finger ; the outer portions similarly empty into the stems coming from the 

 outer surface of the index finger and from the thumb ; while the proximal portions 

 give rise to a number of stems which pass upward along the anterior surface of the 

 forearm. The arrangement, indeed, is very similar to that followed by the veins. 

 At the wrist, then, there are a considerable number (about thirty, more or less) 

 of longitudinal stems which are arranged in two groups, one of which is dorsal and 

 the other ventral (Figs. 810, 811 j. The former consists of the stems which drain 

 the digital net-works and the distal and lateral portions of the palmar net-work, 

 while the latter is formed of stems arising from the proximal portion of the palmar 

 net-work. As they ascend the arm these stems receive afferents from the sub- 



FiG. 810. 



Fig. 811. 



Lymphatics of hand : Fig. Sio, palmar, Fig. 8ii, dorsal surface. Superficial digital net-works (a) empty at bases 

 of fingers into larger stems (fi, c), which are tributary to trunks on forearm (rf) ; superficial palmar ^•essels commu- 

 nicate (Fig. Sio, d) with deeper lymphatics. (Sappey.*) 



cutaneous net-work of the forearm, and at the same time anastomose with one 

 another, so that their number diminishes gradually as they ascend, until, at about 

 the middle of the brachium, they are reduced almost to half the original number. 

 As they approach the elbow (Fig. 809), the stems of the dorsal group divide into 

 two sets, which curve forward, one around the outer border and the other around 

 the inner border of the forearm, so that above the elbow all the principal stems are 

 situated upon the anterior (ventral) surface of the arm, an arrangement which again 

 recalls that presented by the veins. 



Just above the bend of the elbow one or two of the inner stems pass into the 

 epitrochlear nodes (Fig. 809), whose efTerents j^ierce the brachial fascia to empty 

 into the deep brachial lymphatics, but the majority of the remaining stems *Dass 

 directly upward along the anterior surface of the brachium to terminate above in 

 the brachial nodes of the axillary plexus. The most external stem follows, however, 

 a different course (Fig. 809), accompanying the cephalic vein along the groove 

 between the deltoid and pectoralis major muscles ; after traversing the delto-pectoral 



* Description et icoiios^raphie des vaisseaux lymphatiques, 1874. 



