THE NECK. 



*57 



The superficial occipital nodes are just below the superior curved line of the 

 occiput or a little lower down in the hollow below the occiput between the posterior 

 edge of the sternomastoid and anterior edge of the trapezius muscles, resting on the 

 splenius. These are the nodes that are enlarged in syphilis and are to be searched 

 for in endeavoring to establish a diagnosis. 



Superficial and Deep Nodes. The five sets of nodes just described, viz., the 

 submental, submaxillary, superficial upper cervical, posterior auricular, and superficial 

 occipital, are all regarded as superficial nodes. As a matter of fact this division of the 

 lymphatic nodes into superficial and deep is not of practical value. The communica- 

 tion between the various nodes is quite free. Adjacent nodes communicate and the 

 superficial nodes communicate with the deep ones below. 



On account of this an affection is not always limited to a single node but often 

 involves those to each side and those lying still deeper. In the submaxillary region 



Posterior 

 auricular node 



Anterior 

 auricular node 



Occipital node 



Superior deep 

 cervical nodes 



Superficial 

 cervical nodes 



FIG. 181. Superficial lymphatic vessels and nodes of head and neck; semidiaErammatic. (Piersol.) 



the nodes will almost certainly be found to lie under the fascia along with the sub- 

 maxillary gland. When the occipital nodes are enlarged they may not only be 

 found in the space already described but also on the adjacent trapezius and sterno- 

 mastoid muscle and even beneath the outer edge of the trapezius below the deep 

 fascia. 



The Longitudinal Lymphatics. These are along the great vessels, the 

 anterior cervical lymphatics, and in the posterior cervical triangle. 



The anterior cervical lymphatics is the name given to those which tend to show 

 in the anterior cervical triangle either beneath or in front of the sternomastoid 

 muscle, between it and the median line. There are some nodes in the median line 

 but they are almost all deep down in the neck above the sternum. The other nodes 

 may be either superficial or deep, mostly deep, along the edge of the sternomastoid 



