OF THE ABDOMEN AXD PELVIS. 689 



ment of the thoracic duct. In addition to these there are a few small lateral lum- 

 bar t/?'i/t /.> which lie between the transverse processes of the vertebrae, behind the 

 Psoas muscle, and receive lymphatics from the back. 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 testes 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 Lymphatic Vessels of the Abdomen and Pelvis may be divided into two sets, 

 ttiperjicial and deep. 



The superficial lymphatic vessels of the walls of the abdomen and pelvis follow 

 the course of the superficial blood-vessels. Those derived from the integument 

 of the loAver part of the abdomen below the umbilicus follow the course of the 

 superficial epigastric vessels and converge to the superior group of the superficial 

 inguinal glands : a deeper set accompany the deep epigastric vessels, and commu- 

 nicate Avith the external iliac glands. The superficial lymphatics from the sides 

 of the 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, however, run back- 

 ward along Avith the ilio-lumbar and lumbar vessels, to join the lateral lumbar 

 glands. 



The superficial lymphatic vessels of the gluteal region turn horizontally round 

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



The superficial lymphatic vessels of the scrotum and perinaeum folloAT the course 

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



The superficial lymphatic vessels of the penis occupy the sides and dorsum of 

 the organ, the latter receiving the lymphatics from the skin covering the glans 

 penis : they all converge to the upper chain of the superficial inguinal glans. The 

 deep lymphatic vessels of the penis folloAv the course of the internal pudic vessels, 

 and join the internal iliac glands. 



In the female the lymphatic vessels of the mucous membrane of the labia, 

 nymphae, and clitoris terminate in the upper chain of the inguinal glands. 



The deep lymphatic vessels of the abdomen and pelvis take the course of the 

 principal blood-vessels. Those of the parietes of the pelvis, which accompany 

 the gluteal. ischiatic. and obturator vessels, follow the course of the internal iliac 

 arterv. and ultimately join the lumbar lymphatics. 



The efferent vessels from the inguinal glands enter the pelvis beneath Poupart's 

 ligament. A\ here they lie in close relation with the femoral vein ; they then pass 

 through the chain of glands surrounding the external iliac vessels, and finally ter- 

 minate in the lumbar glands. They receive the deep epigastric and circumflex 

 iliac lymphatics. 



The lymphatic vessels of the bladder arise from the entire surface of the 

 organ : l the greater number run beneath the peritoneum on its posterior surface, 

 and. after passing through the lymphatic glands in that situation, join with the 

 lymphatics from the prostate and vesiculae seminales, and enter the internal iliac 

 glands. 



The lymphatic vessels of the rectum are of large size ; after passing through 

 some small glands that lie upon its outer Avail and in the meso-rectum they pass to 

 the sacral glands. 



The lymphatic vessels of the uterus consist of two sets, superficial and deep, 

 the former being placed beneath the peritoneum, the latter in the substance of the 

 organ. The lymphatics of the cervix uteri, together with those from the vagina, 

 enter the internal iliac and sacral glands : those from the body and fundus of the 

 uterus pass outward in the broad ligaments, and, being joined by the lymphatics 



1 Curnow states that they are confined to the base of the organ. 

 44 



