OF THE LOWER EXTREMITY. 565 



Major, as far as the mammary gland, receiving the lymphatics from the front 

 of the chest and mamma ; and others are placed along the lower margin of the 

 posterior wall of the axilla, which receive the lymphatics from the integument 

 of the back. Two or three subclavian lymphatic glands are placed imme- 

 diately beneath the clavicle ; it is through these that the axillary and deep 

 cervical glands communicate with each other. One is figured by Mascagni near 

 the umbilicus. In malignant diseases, tumors, or other affections implicating 

 the upper part of the back and shoulder, the front of the chest and mamma, 

 the upper part of the front and side of the abdomen, or the hand, forearm, and 

 arm, the axillary glands are liable to be found enlarged. 



The superficial lymphatics of the upper extremity arise from the skin of the 

 hand, and run along the sides of the fingers chiefly on the dorsal surface of 

 the hand ; they then pass up the forearm, and subdivide into two sets, which 

 take the course of the subcutaneous veins. Those from the inner border of the 

 hand accompany the ulnar veins along the inner side of the forearm to the 

 bend of the elbow, where they join with some lymphatics from the outer side 

 of the forearm ; they then follow the course of the basilic vein, communicate 

 with the glands immediately above the elbow, and terminate in the axillary 

 glands, joining with the deep lymphatics. The superficial lymphatics from the 

 outer and back part of the hand accompany the radial veins to the bend of the 

 elbow. They are less numerous than the preceding. At the bend of the elbow, 

 the greater number join the basilic group ; the rest ascend with the cephalic 

 vein on the outer side of the arm, some crossing the upper part of the Biceps 



(obliquely, to terminate in the axillary glands, whilst one or two accompany the 

 cephalic vein in the cellular interval between the Pectoralis Major and Deltoid, 

 and enter the subclavian lymphatic glands. 



The deep lymphatics of the upper extremity accompany the deep bloodvessels. 

 In the forearm, they consist of three sets, corresponding with the radial, ulnar, 

 and interosseous arteries ; they pass through the glands occasionally found in 

 the course of those vessels, and communicate at intervals with the superficial 

 lymphatics. In their course upward, some of them pass through the glands 

 which lie upon the brachial artery ; they then enter the axillary and subclavian 

 glands, and at the root of the neck terminate, on the left side, in the thoracic 

 duct, and on the right side in the right lymphatic duct. 



LYMPHATICS OF THE LOWER EXTREMITY. 



The Lymphatic Glands of the Lower Extremity may be subdivided into two 

 sets, superficial and deep ; the former are confined to the inguinal region. 



The superficial inguinal glands, placed immediately beneath the integument, 

 are of large size, and vary from eight to ten in number. They are divisible 

 into two groups ; an upper, disposed irregularly along Poupart's ligament, which 

 receive the lymphatic vessels from the integument of the scrotum, penis, 

 parietes of the abdomen, perineum, and gluteal regions; and an inferior group, 

 which surround the saphenous opening in the fascia lata, a few being sometimes 

 continued along the saphenous vein to a variable extent. The latter receive 

 the superficial lymphatic vessels from the lower extremity. These glands 

 frequently become enlarged in diseases implicating the parts from which their 

 lymphatics originate. Thus, in malignant or syphilitic affections of the prepuce 

 and penis, or of the labia majora in the female, in cancer scroti, in abscess in 

 the perineum, or in any other disease affecting the integument and superficial 

 structures of these parts, or the sub-umbilical part of the abdomen or gluteal 

 region, the upper chain of glands is almost invariably enlarged, the lower chain 

 being implicated in diseases affecting the lower limb. 



The deep lymphatic glands are, the anterior tibial, popliteal, deep inguinal, 

 gluteal, and ischiatic. 



The anterior tibial gland is not constant in its existence. It is generally 



