686 THE LYMPHATICS 



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 lymphatic vessels of the upper extremity accompany the deep blood- 

 vessels. In the forearm they consist of four 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 are divided into two sets, super- 

 ficial and deep. The superficial are confined to the inguinal region, forming the 

 superficial inguinal lymphatic glands. 



The superficial inguinal lymphatic 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 oblique set, disposed irregularly along Pou- 

 part's ligament, which receive the lymphatic vessels from the integument of the 

 scrotum, penis, parietes of the abdomen, perineal and gluteal regions, and the 

 mucous membrane of the urethra ; and an inferior vertical set, which surround the 

 saphenous opening in the fascia lata, a few being sometimes continued along the 

 saphenous vein to a variable extent. This latter group receive the superficial 

 lymphatic vessels from the lower extremity. 



Surgical Anatomy. 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 peri- 

 nseum, or in any other diseases affecting the integument and superficial structures in those parts, 

 or the subumbijical part of the abdominal wall or the 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 gener- 

 ally found by the side of the anterior tibial artery, upon the interosseous mem- 

 brane at the upper part of the leg. Occasionally, two glands are found in 

 this situation. 



The popliteal glands, four or five in number, are of small size ; they surround 

 the popliteal vessels, imbedded in the cellular tissue and fat of the popliteal space. 



The deep inguinal glands are placed beneath the deep fascia around the femoral 

 artery and vein. They are of small size, and communicate with the superficial 

 inguinal glands through the saphenous opening. 



The gluteal and ischiatic glands are placed, the former above, the latter below, 

 the Pyriformis muscle, resting on their corresponding vessels as they pass through 

 the great sacro-sciatic foramen. 



The Lymphatic Vessels of the Lower Extremity, like the veins, may be divided 

 into two sets, superficial and deep. 



The superficial lymphatic vessels are placed beneath the integument in the 

 superficial fascia, and are divisible into two groups : an internal group, which 

 follow the course of the internal saphenous vein ; and an external group, which 

 accompany the external saphenous. The internal group, the larger, commence on 

 the inner side and dorsum of the foot ; they pass, some in front and some behind 



