488 LYMPHATICS. 



the axilla, which receive the lymphatics from the integument of the back. Two 

 pr^three subclavian lymphatic glands are placed immediately beneath the clavicle; 

 it is through these that the axillary and deep cervical glands communicate with 

 each other. One is figured by Mascagni near the umbilicus. In malignant diseases, 

 tumors, or other affections implicating the upper part of the back and shoulder, 

 the front of the chest and mamma, the upper part of the front and side of the 

 abdomen, or the hand, forearm, and arm, the axillary glands are usually found 

 enlarged. 



The superficial lymphatics of the upper extremity arise from the skin of the 

 hand, and run along the sides of the fingers chiefly on the dorsal surface of the 

 hand ; they then pass up the forearm, and subdivide into two sets, which take the 

 course of the subcutaneous veins. Those from the inner border of the hand accom- 

 pany the ulnar veins along the inner side of the forearm to the bend of the elbow, 

 where they join with some lymphatics from the outer side of the forearm ; they 

 then follow the course of the basilic vein, communicate with the glands immediately 

 above the elbow, and terminate in the axillary glands, joining with the deep 

 lymphatics. The superficial lymphatics from the outer and back part of the hand 

 accompany the radial veins to the bend of the elbow, being less numerous than the 

 preceding. Here the greater number join the basilic group ; the rest ascend with 

 the cephalic vein on the outer side of the arm, some crossing obliquely the upper 

 part of the Biceps 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 lymphatics of the upper extremity accompany the deep bloodvessels. 

 In the forearm, they consist of three sets, corresponding with the radial, ulnar, 

 and interosseous arteries ; they pass through the glands occasionally found in the 

 course of these vessels, and communicate at intervals with the superficial lymphatics. 

 In their ascent upwards, 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 may be subdivided into two sets, 

 superficial and deep. 



The superficial lymphatic glands are confined to the inguinal region. 



The superficial inguinal 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, disposed irregularly along Poupart's ligament, receiving 

 the lymphatic vessels from the integument of the scrotum, penis, parietes of the 

 abdomen, perineum, and gluteal regions ; and an inferior group, which surrounds 

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

 the saphenous vein to a variable extent. The latter receive the superficial lymphatic 

 vessels from the lower extremity. These glands frequently become enlarged in 

 diseases implicating the parts from which their efferent lymphatics originate. 

 Thus, in malignant or syphilitic affections of the prepuce and penis, the labia 

 majora in the female, in cancer scroti, in abscess in the perineum, or in any other 

 disease affecting the integument and superficial structures in these parts, or the 

 sub-umbilical part of the abdomen or 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 generally found 

 by the side of the anterior tibial artery, upon the interosseous membrane at the 

 upper part of the leg. Occasionally, two glands are found in this situation. 



