THE LYMPHATICS OF THE PELVIS. 



983 



Fig. S24. 



lumbar node 



which the ureter is crossed by the spermatic (ovarian) artery, pass upward to unite 



with the renal efferents or occasionally to terminate directly in the upper lateral 



lumbar nodes (Fig. 824). The majority 



of the efferents arise from those portions of 



the ducts intervening between the crossing 



of the spermatic (ovarian) arteries and 



the level at which the ureters cross the 



common iliac vessels to enter the pelvis, 



and these vessels pass either to the lower 



lateral lumbar nodes, or else, in the case 



of the lower ones, to the upper iliac 



nodes. Finally, the efferents from the 



pelvic portions of the ureters either unite 



with the vessels passing from the bladder, 



or else communicate directly with certain 



of the hypogastric nodes. 



In and beneath the fibrous capsule 

 of the suprarenal bodies a lymphatic 

 net-work occurs, whose efferents on the 

 one hand join the renal lymphatics, and 

 on the other pass into the substance of 

 the organs to communicate with a net- 

 work situated in the glomerular portion 

 of the cortex. From this latter net-work 

 stems pass centrally in the partitions 

 between the cell columns of the cortex to 

 unite with a rich plexus which traverses 

 all portions of the medullary substance. 

 The main stems of this plexus follow the 

 course of the suprarenal blood-vessels and 

 emerge at the hilus of the organ as four 

 or five stems, which pass to the upper 

 lateral lumbar nodes. Some of the stems are also' said to pierce the crura of the 

 diaphragm and terminate in the lower nodes of the posterior mediastinal group. 



Bladder 



Lymphatics of ureters. (Based on several figures 

 by Sakaia.*) 



THE LYMPHATICS OF THE PELVIS. 

 The Lymph-Nodes. 



The pelvic lymphatic nodes are arranged along the courses of the principal 

 vessels, and may conveniently be divided into three groups, the iliac, the hypogastric, 

 and the sacral nodes. In addition some small inconstant nodes occur in association 

 with the bladder and these will be described in connection with the vessels arising 

 from that organ (page 985). The epigastric and circumflex iliac nodes, already 

 described in connection with the abdominal region (page 972), are really outliers 

 of the iliac group. 



The iliac nodes (Fig. 825) are from fifteen to twenty in number and form a 

 plexus (plexus iliacus externus) along the course of the common and external iliac 

 vessels, the uppermost nodes lying at the level of the bifurcation of the aorta and 

 the lowermost around the point of exit of the external iliac vessels beneath Poupart's 

 ligament. Three more or less distinct linear series of nodes can be recognized in 

 the plexus, one of which, along the course of the common iliac artery, is situated 

 close to the outer surface of the artery and along the medial border of the psoas muscle. 

 The second lies behind the artery, resting upon the anterior surface of the vein, while 

 the third unites with its fellow of the opposite side to form a group of three or four 

 nodes resting upon the left common iliac vein and the promontory of the sacrum 

 in the angle formed by the bifurcation of the aorta. Of the series along the line of 

 the external iliac vessels one lies to the outer side of the artery along the medial 



* Archiv f. Anatom. u. Physiol., 1903. 



