990 



HUMAN ANATOMY. 



Eflerents of 



superior 



group 



Efferents 

 from cervix 

 uteri 



Efferents 



frommiddle 



group 



Efferents 

 from infe- 

 rior group 



Lymphatic net-work of vaginal mucous membrane. (Poirier.*) 



in the inner inguinal nodes. Certain of the stems from the middle portion also pass to 

 the same middle iliac nodes which receive the efferents from the upper portion, and 



stems have been observed 

 Fig. 830. (Bruhns) passing from the 



posterior surface of the vagi- 

 na to the lateral lumbar nodes 

 and even to the iliac nodes 

 situated on the promontory 

 of the sacrum, while others 

 have been traced to the 

 anorectal nodes (page 976). 

 Finally, it may be noted 

 that the superficial net-work 

 of the anterior surface of the 

 vagina communicates with 

 that of the posterior surface 

 of the bladder. 



Practical Considera- 

 tions. — The Lymph-Abodes 

 of the Abdomen and Pelvis. 

 — The stiperficial lymphatics 

 of the wall of the abdomen 

 convey infection, if the pri- 

 mary focus is above the level 

 of the umbilicus, to the axil- 

 lary nodes ; if it is below that 

 level, to the inguinal nodes. 

 Hence, in cases of furuncle or carbuncle, or of chancre, or of epithelioma, the site 

 of the lesion would determine the region in which adenopathy should be sought. 

 The cceliac group of nodes may be involved in diseases of the greater portion of 

 the digestive tract, or of the stomach, spleen, or part of the liver ; or their enlarge- 

 ment may follow that of the lumbar or of the mesenteric nodes. The nodes in and 

 about the portal fissure, or between the layers of the gastro-hepatic omentum may so 

 enlarge in cases of carcinoma of the stomach or of the liver as to compress the portal 

 vein (causing ascites) or the common bile duct (causing jaundice). 



The lymphatic relations of the stomach, liver, spleen, and pancreas have been 

 sufficiently considered from the practical stand-point in connection with these viscera. 

 The mesenteric 7wdes are frequently and gravely involved in various intestinal 

 diseases. They are often infected and enlarged during typhoid fever. They are 

 especially implicated in peritoneal or intestinal tuberculosis. The lymphoid nodules 

 in the neighborhood of Peyer's patches are surrounded by lymphatic plexuses and 

 are a common site of tuberculous ulceration. The bacilli tuberculosis are carried 

 directly thence to the mesenteric glands (tabes mesenterica), and sometimes by way 

 of the lymphatic vessels and thoracic duct, may reach the general circulation in large 

 numbers (generalized tuberculosis, acute miliary tuberculosis). In some cases of 

 tuberculous peritonitis associated with mesenteric gland disease, the mesentery 

 undergoes marked and extreme contraction, so that the altered coils of intestine are 

 held closely to the spine, and their lumen may be greatly narrowed (peritonitis 

 deformans) (Taylor). 



Mesenteric cysts (serous or chylous cysts) are usually of lymphatic origin, and 

 may be due to lymphatic obstruction or to a degeneration and dilatation of the nies- 

 enteric nodes analogous to the varicosity of inguinal nodes in filarial disease. The 

 clinical signs of such cysts are : i, a prominent, fluctuating, usually spherical swell- 

 ing near the vnnbilicus ; 2, marked mobility of the tumor — especially in a transverse 

 direction and around the central axis ; 3, the presence of a zone of resonance around 

 the cyst and a belt of resonance across it (Moynihan). The symptoms may be 



Progres medical, 1890. 



