OF THE PELVIS AND ABDOMEN. 567 



pany the external saphenous vein along the back of the leg, where they enter 

 the popliteal glands. 



The deep lymphatics of the lower extremity are few in number, and accompany 

 the deep bloodvessels. In the leg, they consist of three sets, the anterior tibia!, 

 peroneal, and posterior tibial, which accompany the corresponding bloodvessels, 

 two or three to each artery ; they ascend with the bloodvessels, and enter the 

 lymphatic glands in the popliteal space ; the efferent vessels from these glands 

 accompany the femoral vein, and join the deep inguinal glands ; from these, 

 the vessels pass beneath Poupart's ligament, and communicate with the chain 

 of glands surrounding the external iliac vessels. 



The deep lymphatics of the gluteal and ischiatic regions follow the course 

 of the bloodvessels, and join the gluteal and ischiatic glands at the great 

 sacro-sciatic foramen. 



LYMPHATICS OF THE PELVIS AND ABDOMEN. 



The Deep Irymphatic Glands in the Pelvis are, the external iliac, the internal 

 iliac, and the sacral. Those of the abdomen are the lumbar glands. 



The external iliac glands form an uninterrupted chain round the external iliac 

 vessels, three being placed round the commencement of the vessel just behind 

 the crural arch. They communicate below with the femoral lymphatics, and 

 above with the lumbar glands. 



The internal iliac glands surround the internal iliac vessels; they receive the 

 lymphatics corresponding to the branches of the internal iliac artery, and 

 communicate with the lumbar glands. 



The sacral glands occupy the sides of the anterior surface of the sacrum, 

 some being situated in the meso-rectal fold. These and the internal iliac 

 glands are affected in malignant disease of the bladder, rectum, or uterus. 



The lumbar glands are very numerous; they are situated on the front of the 

 lumbar vertebrae, surrounding the common iliac vessels, the aorta, and vena 

 cava; they receive the lymphatic vessels from the lower extremities and 

 pelvis, as well as from the testes and some of the abdominal viscera; the 

 efferent vessels from these glands unite into a few large trunks, which, with 

 the lacteals, form the commencement of the thoracic duct. In some cases of 

 malignant disease, these glands become enormously enlarged, completely 

 surrounding the aorta and vena cava, and occasionally greatly contracting the 

 calibre of those vessels. In all cases of malignant disease of the testis, and in 

 malignant disease of the lower limb, before any operation is attempted, careful 

 examination of the abdomen should be made, in order to ascertain if any 

 enlargement exists; and if any should be detected, all operative measures 

 should be avoided as fruitless. 



The Lymphatics of the Pelvis and Abdomen may be divided into two sets, 

 superficial and deep. 



The superficial lymphatics of the walls of -the abdomen and pelvis follow the 

 course of the superficial bloodvessels. Those derived from the integument 

 of the lower part of the abdomen below the umbilicus, follow the course of the 

 superficial epigastric vessels, and converge to the superior group of the super- 

 ficial inguinal glands; the deep set accompany the deep epigastric vessels, and 

 communicate with the external iliac glands. The superficial lymphatics from 

 the sides and lumbar part of the abdominal wall wind round the crest of the 

 ilium, accompanying the superficial circumflex iliac vessels, to join the 

 superior group of the superficial inguinal glands; the greater number, how- 

 ever, run backwards along with the ilio-lumbar and lumbar vessels, to join the 

 lumbar glands. 



The superficial lymphatics of the gluleal region turn horizontally round the 

 outer side of the nates, and join the superficial ingunial glands. 



The superficial lymphatics of the scrotum and perineum follow the course of 

 the external pudic vessels, and terminate in the superficial inguinal glands. 



