THE LYMPHATICS OF THE PELVIS. 



989 



Fig. 829. 



Sacral nodes 



In the uterus (Figs. 828, 829) the conditions are much more favorable for 

 determining the existence of separate ne^vvorks in the mucosa and muscularis than 

 in the Fallopian tubes, but, nevertheless, much difference of opinion exists as to the 

 occurrence of a mucosa net-work. That of the muscularis can be injected without 

 difficulty, but no conclusive injections have yet been made of the mucosa, and while 

 some authors (Bruhns, Sappey, Poirier) are inclined to admit the existence of a 

 net- work in it, others (Leopold) deny it. However that may be, a well-developed 

 net-work occurs in the muscular coat, in the deeper portions of which it becomes 

 especially rich, and, furthermore, it is more abundant in the cervix than in the body 

 or fundus. From it stems pass to the surface of the organ to form a subserous 

 net-work, from which a number of eflerents arise. 



These may be divided into three principal groups according to their termina- 

 tions. ( I ) The eflerents from the fundus, usually two in number, pass outward on 

 either side in the upper portion of the broad ligament, and, associating themselves 

 with the ef!erents from the ovary, terminate in the lateral lumbar nodes. (2) Small 

 stems pass from the fundus along the round ligament of the uterus to terminate in the 

 inguinal nodes. (3) The 

 eflerents from the body 

 and cervix pass laterally 

 to terminate in the median 

 iliac riodes situated in the 

 angfle between the external 

 and internal iliac arteries. 

 In the course of these last 

 vessels, at the point where 

 they cross the ureter, a 

 small titero-vagmal node 

 is occasionally placed. 



Other efferents have 

 been described as oassino" 

 from the cervix to a hypo- 

 gastric node situated at 

 the origin of the uterine or 

 vaginal artery, and two or 

 three stems have been 

 found arising from the 

 posterior surface of the 

 cervix and passing back- 

 ward on either side of 

 the rectum to the anterior 

 surface of the sacrum, 

 up which they pass to 

 terminate in the iliac nodes situated upon the sacral promontory (Fig. 829). 



In the vagina there is no question as to the existence of definite net-works in 

 both the mucosa and muscularis. That of the mucosa (Fig. 830) is exceptionally 

 fine and communicates abundantly with the coarser net-work of the muscularis, as 

 well as with the net-work of the vaginal portion of the cervix above and with that of 

 the labia minora below. From the muscularis net-work stems pass to the surface 

 of the organ to form a third net-work, from which the main efferent stems arise, 

 and these may be arranged in three groups according to their destinations: (i) 

 those which arise from the upper portion of the vagina join the stems which pass 

 from the cervix of the uterus (Fig. 830) and terminate with these in the median 

 iliac nodes situated in the angle formed by the external and internal iliac arteries ; 

 (2) those arising from the middle portion accompany the vaginal vessels, passing 

 obliquely upward, outward, and backward, to terminate in one or two hypogastric 

 nodes situated at the origin of the uterine arteries ; and (3) those from the lower 

 portion associate themselves with those from the labia minora and terminate with these 



Right 



common 



iliac artery 



Right ovary 



Lymphatic 

 vessels from 

 fundus uteri 



Uterus 



Bladder 



Hypogastric 

 nodes 



Lymphatics of uterus. {Cuneo and Marcille.*) 



*Bull. et Mem. Soci^t^ anatom., 1902. 



