684 THE LYMPHATICS 



situated about the bifurcation of the common carotid and along the upper part 

 of the internal jugular vein ; and a loiver, ten to fifteen in number, clustered around 

 the lower part of the internal jugular vein, and extending outward into the supra- 

 clavicular fossa, where they are continuous with the axillary glands. Internally, 

 this set is continuous with the mediastinal glands. 



The superficial and deep cervical lymphatic vessels are a continuation of those 

 already described on the cranium and face. After traversing the glands in those 

 regions, they pass through the chain of glands which lie along the sheath of the 

 carotid vessels, being joined by the lymphatics from the pharynx, oesophagus, 

 larynx, trachea, and thyroid gland. At the lower part of the neck, after receiving 

 some lymphatics from the thorax, they unite into a single trunk, which terminates, 

 on the left side, in the thoracic duct; on the right side, in the right lymphatic 

 duct. 



Surgical Anatomy. The cervical glands t are very frequently the seat of tuberculous 

 trouble. This condition is most usually set up by some lesion in those parts from which they 

 receive their lymph. This excites some inflammation, which subsequently takes on a tuberculous 

 character. It is very desirable, therefore, for the surgeon, in dealing with these cases, to possess 

 a knowledge of the relation of the respective groups of glands to the periphery. The following 

 table is extracted from Mr. Treves's work on Scrofula audits Gland Diseases : 



Scalp. Posterior part = suboccipital and mastoid glands. Frontal and parietal portions = 

 parotid glands. 



Lymphatic vessels from the scalp also enter the superficial cervical set of glands. 



Skin of face and neck = submaxillary, parotid, and superficial cervical glands. 



External ear = superficial cervical glands. 



Lower lip = submaxillary and suprahyoid glands. 



Buccal cavity = submaxillary and upper set of deep cervical glands. 



Gums of lower jaw = submaxillary glands. 



Tongue. Anterior portion = suprahyoid and submaxillary glands. Posterior portion = 

 upper set of deep cervical glands. 



Tonsils and palate = upper set of deep cervical glands. 



Pharynx. Upper part = parotid and retro-pharyngeal glands. Lower part = upper set of 

 deep cervical glands. 



Larynx, orbit, and roof of mouth = upper set of deep cervical glands. 



Nasal fossa? = retro-pharyngeal glands, upper set of deep cervical glands. Some lymphatic 

 vessels from posterior part of tbe fossae enter tbe parotid glands. 



LYMPHATICS OF THE UPPER EXTREMITY. 



The Lymphatic Glands of the Upper Extremity (Fig. 397) are divided into two 

 sets, superficial and deep. 



The superficial lymphatic glands are few and of small size. There are occa- 

 sionally two or three in front of the elbow, and one or two above the internal 

 condyle of the hurnerus, near the basilic vein. 



The deep lymphatic glands are few in number, and are subdivided into 

 those in the forearm, the arm, and the axilla. In the forearm a few small 

 ones are occasionally found in the course of the radial and ulnar vessels. In the 

 arm there is a chain of small glands along the inner side of the brachial artery. 

 One, sometimes two, fairly constant glands are situated a little above and in front 

 of the inner condyle of the humerus. In the axilla they are of large' size, and 

 usually ten or twelve in number. A chain of these glands surrounds the axillary 

 vessels, imbedded in a quantity of loose areolar tissue ; they receive the lymphatic 

 vessels from the arm ; others are dispersed in the areolar tissue of the axilla ; the 

 remainder are arranged in two series, a small chain running along the lower 

 border of the Pectoralis major, 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 immediately beneath the 

 clavicle; it is through these that the axillary and deep cervical glands communi- 

 cate with each other. 



Surgical Anatomy. In malignant diseases, tumors, or other affections implicating tbe 

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



